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.
