Key result
Argatroban with a delayed 9-week transition to warfarin successfully manages pediatric HIT without re-thrombosis.
Case Report (n=1)
In pediatric HIT, delaying the transition to warfarin and using argatroban monitored with chromogenic factor X levels may reduce the risk of re-thrombosis.
May support delayed warfarin transition in select pediatric HIT cases; leaves open need for prospective validation before practice change.
An 11-year-old female developed heparin induced thrombocytopenia (HIT) with thrombosis during therapy for lower extremity deep vein thrombosis and pulmonary embolism. Transition from bivalirudin, a direct thrombin inhibitor (DTI), to warfarin resulted in extensive re-thrombosis, and fondaparinux therapy similarly failed. She was then treated with argatroban, and transitioned successfully to warfarin after 9 weeks. The risk of re-thrombosis was ultimately reduced by allowing time for the thrombogenic potential to abate. The argatroban/warfarin transition was monitored with chromogenic factor X levels. This case highlights several difficult problems in pediatric thrombosis.
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Maurer et al. (2009) conducted a case report in Heparin induced thrombocytopenia (HIT) with thrombosis (n=1). Argatroban transitioned to warfarin was evaluated. Treatment with argatroban followed by a delayed transition to warfarin after 9 weeks successfully managed heparin-induced thrombocytopenia and re-thrombosis in an 11-year-old female.
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