Keywords

anticoagulants, catheter-directed thrombolysis, direct-thrombin inhibitors, heparin-induced thrombocytopenia, thrombocytopenia, thrombolytic therapy, venous thromboembolism

Authors

1. Badreldin, Hisham A. PharmD, BCPS, ASH-CHC
2. Albassam, Ghada PharmD
3. Aldoughaim, Maha PharmD
4. Alyami, Majed PharmD, BCPS, ASH-CHC

Abstract

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.