Comparing Length of Argatroban Use Among Patients Managed With Warfarin Versus Apixaban or Rivaroxaban for the Treatment of Suspected Heparin-Induced Thrombocytopenia

Background: There is limited available data directly comparing warfarin versus direct oral anticoagulants (DOACs) for the treatment of acute or suspected heparin-induced thrombocytopenia (HIT). In addition, there are no studies assessing the difference in duration of parenteral anticoagulation when switched to a DOAC versus warfarin in this setting. Objective: The purpose of this study is to determine if transitioning to rivaroxaban or apixaban versus warfarin is associated with a shorter duration of argatroban administration. Methods: This single-center retrospective chart review included adults with suspected or acute HIT treated with argatroban and transitioned directly to warfarin, apixaban, or rivaroxaban. The primary outcome was duration of argatroban therapy. Secondary outcomes included hospital length of stay, bleeding events, new or recurrent thrombosis, and survival to discharge. Results: Seventeen patients in the apixaban and rivaroxaban group and 27 patients in the warfarin group were included. Patients transitioned to apixaban or rivaroxaban had a significantly shorter duration of argatroban infusion compared with the warfarin group (3.8 days vs 11.2 days, respectively [ P < .001]). Although hospital length of stay was numerically shorter with DOACs, the difference was not statistically significant. Conclusion and Relevance: In this study, transitioning to apixaban or rivaroxaban from argatroban for suspected or acute HIT was associated with a shorter duration of argatroban infusion. Application of this data may help reduce the duration of argatroban infusion for those with suspected or acute HIT being transitioned to oral anticoagulation.