Clinical experience with combined treatment of thrombin inhibitors and GPIIb IIIa inhibitors in patients with HIT

Despite the use of potent anticoagulants such as r-hirudin and argatroban, the morbidity/ mortality of heparin-induced thrombocytopenia (HIT) patients remains high. In the last several months, we have treated three HIT-positi ve patients with a combined therapy of thrombin inhibitor and GPIIb/IIIa in hibitor when treatment with thrombin inhibitor alone failed to alleviate ac ute thrombosis. Combination therapies included r-hirudin (Refludan(R)) with tirofiban (Aggrastat(R)) or argatroban (Novastan(R)) with ReoPro(R), A red uced dose of the thrombin inhibitor with the standard dose of the antiplate let drug was the dosing regimen used. In all cases, there was no overt blee ding that required intervention and all patients had improved or fully reco vered. This first report of the use of GPIIb/IIIa inhibitors,vith thrombin inhibitors in HIT patients with active thrombosis suggests that this combin ed therapy may be more effective than thrombin inhibitor treatment alone. T he data from these three cases warrant testing of this therapeutic regimen in larger studies to determine optimal dosing strategies.