A case of probable bemiparin-induced heparin-induced thrombocytopenia type II managed with low-dose fondaparinux

AN Koul 
 Department of Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Correspondence Address:
A N Koul
Department of Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
India

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Sir,

I want to make following observations regarding the article, "a case of probable bemiparin-induced heparin-induced thrombocytopenia (HIT) type II managed with low-dose fondaparinux" published in your esteemed journal.

The profile of the patient is not completely recorded. Patient in question may have thrombocytopenia due to sepsis or ischemic abdomen with disseminated intravascular coagulation. She has abdominal pain, high lactate dehydrogenase, respiratory alkalosis, and the cause for her pain is not ascertained. As this patient had undergone surgery recently, there could be multiple causes for low platelet countFondaparinux is not a drug of choice for HIT. It is advisable to use direct thrombin inhibitors like argatroban or bivalirudin. They are Food and Drug Administration (FDA) approved drugs to be used in patients of thrombosis with HIT. Novel anticoagulant drugs such as rivaroxaban, dabigatran, and apixaban are being used as an alternative therapy for HIT but are not FDA approved, nor American College of Chest Physicians recommends them. Fondaparinux is recommended to be used in pregnant patients who develop HIT [1],[2] The authors have replaced fondaparinux with acenocoumarol after some time without overlap therapy. Such a step could have increased the risk of paradoxical thrombosis or skin necrosis in protein C or S deficiency. [2]

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