Objective: Drugs currently in use for the management of heparin-induced thrombocytopenia
(HIT) have their limitations. Several new oral anticoagulants (NOACs) such as dabigatran,
rivaroxaban and apixaban may offer attractive therapy options for HIT. Although the clinical data are
sparse on this topic, we have summarized the available clinical data, discussed pertinent in-vitro
studies and provided the rational and advantages of using NOACs in patients with suspected or confirmed HIT. We have
also reviewed the safety and efficacy of these NOACs in patients with HIT based on published literature.
Methods: We reviewed all suspected or confirmed HIT cases treated with NOACs and indexed in English language in
MEDLINE and EMBASE by July 2015. The bibliography of each relevant article was searched for additional reports.
In-vitro studies and other pertinent literature were briefly discussed.
Results: A total of 36 HIT patients were treated with the following NOACs: rivaroxaban (50%), dabigatran (36%) and
apixaban (14%). Sixty-one percent of patients received argatroban bolus before NOACs and 3% received rivaroxaban
after a lack of response with three-day course of fondaparinux. Three percent (n=1) received rivaroxaban after the patient
responded to intravenous immunoglobulin for 2 days, following a lack of response to fondaparinux and bilvalirudin. In
another 3% (n=1), prophylactic dose of rivaroxaban was used for 21 days and then changed to dabigatran because of
persistent thrombocytopenia. All cases responded with early signs of clinical improvement and increase in platelet counts.
A follow-up after a median 47 days (range 4- 450) reported no bleeding or thrombotic complications.
Conclusion: In this review, all patients with HIT treated with NOACs responded without any bleeding or thrombotic
complication. Although the argatroban bolus might have contributed to a response in some patients, response to NOAC
alone in other patients and in-vitro studies provide a proof of principle that NOACs can be effective in the management of
HIT. Additionally, properties such as rapid onset of action, oral administration, ease of use and a lack of need for
monitoring make these drugs attractive options for HIT. However, given several limitations of prior reports, further
confirmation of the results are desirable.