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Current Drug Therapy

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ISSN (Print): 1574-8855
ISSN (Online): 2212-3903

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

Author(s): Mehdi Salimi and Foroud Shahbazi*

Volume 19, Issue 5, 2024

Published on: 07 September, 2023

Page: [503 - 510] Pages: 8

DOI: 10.2174/1574885519666230825153414

Price: $65

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.

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

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