The role of direct oral anticoagulants (DOACs) in the treatment of heparin-induced thrombocytopenia (HIT): An evidence-based literature review

Abstract

Heparin-induced thrombocytopenia (HIT) poses a risk of death secondary to thrombotic complications.Treatment options are limited for patients with poor IV access, as contemporary options are restricted to parenteral agents before switching to oral vitamin k antagonists. A literature review was conducted to examine the effectiveness of direct oral anticoagulants (DOACs) in the primary treatment of HIT. High quality evidence is scarce surrounding the use of DOACs for this indication, while past reviews have not critically appraised the evidence. Additionally, the most recent study from 2017 investigating the use of DOACs for this indication has not been reported in past literature reviews.The Cochrane Library, Embase, PubMed, Google Scholar and ClinicalTrials.gov were searched to identify and critically appraise the best available evidence. Salient literature demonstrates that DOACs are effective at raising platelet count to baseline after seven days, on average.Thrombosis and major bleeding are rarely observed when DOACs are used as primary therapy. While large scale studies are needed, patients with HIT that have poor IV access may benefit from the ease of administration, rapid onset of action and lack of routine monitoring associated with DOAC therapy.