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Direct-Thrombin Inhibitor Utilization in Patients With Heparin-Induced Thrombocytopenia and Undergoing Catheter-Directed Thrombolysis

A Summary of Published Case Reports

Badreldin, Hisham A., PharmD, BCPS, ASH-CHC; Albassam, Ghada, PharmD; Aldoughaim, Maha, PharmD; Alyami, Majed, PharmD, BCPS, ASH-CHC

Journal of Cardiovascular Nursing: May/June 2019 - Volume 34 - Issue 3 - p 244–249
doi: 10.1097/JCN.0000000000000555
ARTICLES: Outcomes
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Background: Catheter-directed thrombolysis (CDT) is one of the emerging venous thromboembolism management modalities. There are fairly limited data regarding the use of direct-thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia and undergoing CDT.

Objectives: The aim of this study was to provide a summary of the available evidence supporting the use of DTIs in patients undergoing CDT.

Methods and Results: We included 6 case reports in our analysis after searching for peer-reviewed articles and case reports in multiple research engines. Four of the 6 cases used argatroban, and 2 cases used bivalirudin. Alteplase was used in all of the 6 cases. All cases used lower activated partial thromboplastin time target. The average initial dose of alteplase ranged from 0.5 to 3 mg/h. The average duration of CDT was 26 hours (SD, 13 hours). Five patients (83%) survived after the procedure, and no complications were reported.

Conclusions: The use of DTIs might be safe and effective in selected patients with heparin-induced thrombocytopenia and undergoing CDT.

Hisham A. Badreldin, PharmD, BCPS, ASH-CHC Assistant Professor of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Cardiovascular Clinical Pharmacist, King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Ghada Albassam, PharmD Teaching Assistant of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Pharmacist, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Maha Aldoughaim, PharmD Teaching Assistant of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Pharmacist, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Majed Alyami, PharmD, BCPS, ASH-CHC Assistant Professor of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, and Clinical Pharmacist, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

The authors have no funding or conflicts of interest to disclose.

Correspondence Hisham A. Badreldin, PharmD, BCPS, ASH-CHC, King Saud bin Abdulaziz University for Health Sciences, and King Abdulaziz Cardiac Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Hishamahmed87@gmail.com).

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