AUTHOR=Carré Julie , Guérineau Hippolyte , Le Beller Christine , Mauge Laëtitia , Huynh Benoit , Nili Roya , Planquette Benjamin , Clauser Sylvain , Smadja David M. , Helley Dominique , Lillo-Le Louet Agnès , Gendron Nicolas , Calmette Leyla 

TITLE=Direct Oral Anticoagulants as Successful Treatment of Heparin-Induced Thrombocytopenia: A Parisian Retrospective Case Series

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.713649

DOI=10.3389/fmed.2021.713649

ISSN=2296-858X

ABSTRACT=Background: Heparin induced thrombocytopenia (HIT) is a prothrombotic life-threatening disorder caused by an adverse reaction to heparin exposure. In this context, it is imperative to stop heparin immediately and to replace it by a non-heparin anticoagulant therapy. Despite their advantages, the use of direct oral anticoagulants (DOACs) is only emerging for HIT treatment, and their use remains rare. 
Objective: To improve our knowledge on the emerging role of DOACs as treatment of HIT and give an overview of our local practices in this context.
Patients/Methods: This is a multi-centric retrospective case series of HIT patients referred to our Parisian pharmacovigilance network and treated with DOACs.
Results: We report the cases of 7 patients from 4 healthcare centers, diagnosed with HIT (4T score ≥ 4, positive anti-PF4/heparin immunoassay and positive serotonin-release assay) and treated with DOACs. After a few days on substitutive parenteral treatment (n=6) or directly at HIT diagnosis (n=1), these patients were treated with either rivaroxaban (n=6) or apixaban (n=1) during acute HIT phase. Mean time to platelet count recovery after heparin discontinuation was 3.3 days (range 3 – 5). No patient experienced major or clinically relevant non-major bleeding or thrombosis that could be related to DOAC treatment during follow-up. 
Conclusions: Our cases studies are consistent with recent guidelines credit to the potential and safe use of DOAC during acute HIT in clinically stable patients.r