Successful use of fondaparinux for perioperative bridging in a patient with a mechanical heart valve and heparin-induced thrombocytopenia

• Main Authors: C R Pruthvi, Krishna Prasad, Dinakar Bootla, V Krishna Santosh, Parag Barwad
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Journal of Applied Hematology
• Subjects: bridging anticoagulation; fondaparinux; heparin-induced thrombocytopenia; mitral valve replacement
• Online Access: http://www.jahjournal.org/article.asp?issn=1658-5127;year=2019;volume=10;issue=4;spage=146;epage=148;aulast=Pruthvi

The mechanical heart valve prosthesis is a thrombotic state requiring anticoagulation at therapeutic doses. Heparin-induced thrombocytopenia (HIT) is both a thrombotic and bleeding state which has a high chance of recurrence when heparin is reinitiated. Unfractionated heparin and low molecular-weight heparin are the standard of care for bridging therapy that are on anticoagulation with warfarin for various reasons. However, perioperative bridging in patients having a prior history of HIT is often elusive. We successfully used fondaparinux as a bridging agent for warfarin in a mitral valve replacement patient with a history of HIT.