Wilbur Freeman

New oral anticoagulants in the treatment of heparin- Induced thrombocytopenia

BACKGROUND Heparin induced thrombocytopenia (HIT) is a potentially catastrophic syndrome with a high incidence of vascular thrombosis. There are little data on the efficacy of new oral anticoagulants (NOAC) in this setting. This study reports on the outcome of patients with HIT, treated with NOAC. MATERIALS AND METHODS We retrospectively identified 22 patients with HIT who were treated by our group with a combination of NOAC and a short course of argatroban. These patients were evaluated in a prospective fashion for development of outcomes at a mean follow up of 19±3 months. RESULTS There were a total of 5 deep and 2 superficial vein thromboses diagnosed at index hospitalization. No patient developed arterial thrombosis. All patients tolerated NOAC and their platelet count normalized before discharge. At 19 months of follow-up, 6 patients had died of non-thrombotic causes. There was no bleeding, limb loss or recurrent venous thromboembolism in any patient. CONCLUSIONS In patients with HIT, a short course of parenteral treatment with argatroban followed by administration of a NOAC is highly safe and effective in prevention of thrombosis and normalization of platelet count. Development of HIT however, portends a poor prognosis independent of vascular thrombosis.

Low incidence of post-thrombotic syndrome in patients treated with new oral anticoagulants and percutaneous endovenous intervention for lower extremity deep venous thrombosis.

Post-thrombotic syndrome (PTS) is a common complication of deep venous thrombosis (DVT) of the iliofemoral venous system leading to significant morbidity and high health care costs. It has been recently shown that percutaneous endovenous intervention (PEVI) can effectively reduce the incidence of PTS. The role of new oral anticoagulants (NOACs) in combination with PEVI in the reduction of PTS has not been previously studied. This report sought to evaluate the role of PEVI plus NOACs in the reduction of PTS in acute symptomatic femoropopliteal and iliac DVT. We studied 127 patients with acute lower extremity DVT who had undergone PEVI plus administration of NOACs. All had received a minimum of 3 months of anticoagulation with a NOAC following PEVI. The mean follow-up was 22±5 months. The patients were evaluated for development of PTS, bleeding, recurrent venous thromboembolism (VTE), duration of hospitalization and mortality. There was no in-hospital bleeding. The mean duration of hospitalization was 46±9 hours. DVT occurred in two patients who had been later switched to warfarin. There were four non-VTE-related deaths. PTS developed in five patients (3%), two of whom were those who had been switched to warfarin. Their mean Villalta score was 6.2±0.9. We conclude that the combination of PEVI plus NOAC and low dose aspirin is associated with a very low rate of PTS with the severity being only mild. This approach leads to very low rates of bleeding and recurrent VTE and promotes early discharge.

LOW DOSE SYSTEMIC THROMBOLYSIS AND NEW ORAL ANTICOAGULANTS IN THE TREATMENT OF LARGE THROMBI IN THE RIGHT HEART

Background: Large right heart thrombi are infrequently encountered in patients with pulmonary embolism (PE). There is an understandable concern that thrombolytic therapy can dislodge such clots and worsen the clinical condition by causing large PEs. We report on 28 patients who were successfully

PERCUTANEOUS ENDOVENOUS INTERVENTION PLUS NEW ORAL ANTICOAGULANTS IN CANCER PATIENTS WITH LOWER EXTREMITY DEEP VENOUS THROMBOSIS

Deep venous thrombosis (DVT) portends a poor prognosis in patients with cancer. The treatment of choice has been low molecular weight heparins ( LMWH). Due to presence of resistance, warfarin is not the preferred anticoagulant . There is a paucity of data on the use of new oral anticoagulants (NOAC