Severe and Prolonged Thrombocytopenia Following Heparin and Apixaban Use: A Case Report and Literature Review

Title:Severe and Prolonged Thrombocytopenia Following Heparin and Apixaban Use: A Case Report and Literature Review

Volume: 19 Issue: 5

Author(s): Mehdi Salimi and Foroud Shahbazi*

Affiliation:

• Department of Clinical Pharmacy, School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran

Keywords: Heparin, thrombocytopenia, direct oral anticoagulants, IVIG, immune mechanism, immunoglobulin.

Abstract: Drug-induced thrombocytopenia can occur in hospitalized patients and complicate their antithrombotic treatment. Several medications can associate thrombocytopenia with immune and nonimmune mechanisms. Thrombocytopenia can occur at any time from a few hours to months after a new medication initiation. In this study, we have described the case of a female patient with acute-onchronic kidney injury following a non-steroidal anti-inflammatory agent use, who developed catheterrelated thrombosis and was treated with heparin without any complication for 5 days. She was discharged after 5 days and prescribed to use apixaban 2.5 mg twice daily. However, she was readmitted after 24 hours with fatigue, petechiae, and severe thrombocytopenia (7000/mm³). The workup was negative for other reasons of thrombocytopenia. With a possible diagnosis of drug-related thrombocytopenia, apixaban was discontinued. Following the treatment with the intravenous immunoglobulin, her platelet counts increased and stabilized around 40-50,000/mm³. Anticoagulation was thus continued with adjusted doses of rivaroxaban (10-15 mg/day). 17 days after apixaban discontinuation and treatment with prednisolone, her platelet count increased to 108,000/mm3. With reference to this case, a brief review on refractory heparin-induced thrombocytopenia and the association of direct oral anticoagulants with thrombocytopenia is presented.

Cite this article as:

Salimi Mehdi and Shahbazi Foroud*, Severe and Prolonged Thrombocytopenia Following Heparin and Apixaban Use: A Case Report and Literature Review, Current Drug Therapy 2024; 19 (5) . https://dx.doi.org/10.2174/1574885519666230825153414