Recent Advances in Anticoagulant Treatment of Immune Thrombosis: A Focus on Direct Oral Anticoagulants in Heparin-Induced Thrombocytopenia and Anti-Phospholipid Syndrome.

Hematology Department, CHU de Poitiers, 86021 Poitiers, France. Research Center, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada. Faculty of Pharmacy, Université de Montréal, Montreal, QC H3T 1J4, Canada. Innovative Therapies in Haemostasis, INSERM UMR-S1140, University of Paris, 75006 Paris, France. Biosurgical Research Lab (Carpentier Foundation), AP-HP, 75015 Paris, France. Biological Hematology Department, Assistance Publique-Hôpitaux de Paris-Centre (AP-HP.CUP), 75015 Paris, France. Paris Cardiovascular Research Center, INSERM UMR-S970, 75015 Paris, France.

International journal of molecular sciences. 2021;(1)
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Abstract

For more than 10 years, direct oral anticoagulants (DOACs) have been increasingly prescribed for the prevention and treatment of thrombotic events. However, their use in immunothrombotic disorders, namely heparin-induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS), is still under investigation. The prothrombotic state resulting from the autoimmune mechanism, multicellular activation, and platelet count decrease, constitutes similarities between HIT and APS. Moreover, they both share the complexity of the biological diagnosis. Current treatment of HIT firstly relies on parenteral non-heparin therapies, but DOACs have been included in American and French guidelines for a few years, providing the advantage of limiting the need for treatment monitoring. In APS, vitamin K antagonists are conversely the main treatment (+/- anti-platelet agents), and the use of DOACs is either subject to precautionary recommendations or is not recommended in severe APS. While some randomized controlled trials have been conducted regarding the use of DOACs in APS, only retrospective studies have examined HIT. In addition, vaccine-induced immune thrombotic thrombocytopenia (VITT) is now a part of immunothrombotic disorders, and guidelines have been created concerning an anticoagulant strategy in this case. This literature review aims to summarize available data on HIT, APS, and VITT treatments and define the use of DOACs in therapeutic strategies.

Methodological quality

Publication Type : Review

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