| 19415734 |
Maurer SH, Wilimas JA, Wang WC, Reiss UM: Heparin induced thrombocytopenia and re-thrombosis associated with warfarin and fondaparinux in a child. Blood Coagul Fibrinolysis. 2010 Mar;21(2):144-51.
An 11-year-old female developed heparin induced thrombocytopenia (HIT) with thrombosis during therapy for lower extremity deep vein thrombosis and pulmonary embolism. Transition from bivalirudin, a direct thrombin inhibitor (DTI), to warfarin resulted in extensive re-thrombosis, and fondaparinux therapy similarly failed. She was then treated with argatroban, and transitioned successfully to warfarin after 9 weeks. The risk of re-thrombosis was ultimately reduced by allowing time for the thrombogenic potential to abate. The argatroban/warfarin transition was monitored with chromogenic factor X levels. This case highlights several difficult problems in pediatric thrombosis. |
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