PB0696 - Treatment of Heparin-Induced Thrombocytopenia in Patients with Renal Impairment: A 15-Year Experience in a Country with Limited Access to Non-Heparin Anticoagulants

Background: Managing anticoagulation in heparin-induced thrombocytopenia (HIT) patients with severe renal insufficiency in countries without alternative non-heparin anticoagulants, poses challenges.

Aims: To assess bleeding and thrombotic outcomes in HIT patients with a CrCl below 30 mL/min

Methods: We conducted a retrospective study on patients with suspected or confirmed diagnoses of HIT and a CrCl below 30 mL/min.

Results: Seventeen patients were enrolled; 58.8% were male with a mean age of 69±13 years. Two patients had pre-existing end-stage renal disease, and 58.8% of patients required renal replacement therapy (RRT) during admission. The median length of stay was 36 (30-54) days. The mean 4Ts score was 5±1. All but two were positive for both HIT/PF4 antibody and heparin-induced platelet aggregation (HIPA), commonly indicated for thromboprophylaxis of vascular access. Two patients presented HIT with thrombosis (1 deep vein thrombosis and 1 coronary stent thrombosis). Treatment included varied doses of fondaparinux (10) with a median peak anti-Xa assay of 0.75 (0.60-1.12), regional citrate flush (4), and no treatment (3) (Figure 1). The overall cumulative incidence of bleeding was 35.29% (5 major and 1 clinically relevant non-major bleeding by ISTH criteria). Incidences for patients treated with fondaparinux, citrate flush, and no treatment were 40%, 25%, and 33.3%, respectively. The rates showed no significant differences between fondaparinux and citrate flush (HR = 1.58, P = 0.69) or between fondaparinux and no treatment (HR = 1.20, P = 0.87) (Figure 2). No statistically significant associations were found between bleeding and heparin indication, anti-Xa level, fondaparinux dose, RRT, and age. Nine patients died, one with gastrointestinal bleeding and another untreated patient from a pulmonary embolism two days after HIT diagnosis.

Conclusion(s): HIT patients with severe renal insufficiency exhibited high rates of bleeding. The incidence appeared to be higher in individuals who received fondaparinux, underscoring the necessity for tailored management in this challenging population.