HIT and Cancer VTE — SCE Medical Oncology MCQ

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HardOncological EmergenciesHIT and Cancer VTESCE Medical Oncology

A 70-year-old woman with advanced pancreatic cancer develops an unprovoked pulmonary embolism during chemotherapy. She has recently been diagnosed with heparin-induced thrombocytopenia (HIT). What anticoagulant should be used?

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Correct answer: A — Fondaparinux or a DOAC (argatroban if parenteral needed)

In HIT, all heparin products (UFH and LMWH) are contraindicated due to cross-reactivity with HIT antibodies. Fondaparinux (a synthetic pentasaccharide with minimal HIT cross-reactivity) or a direct oral anticoagulant (rivaroxaban, apixaban) are appropriate alternatives for cancer-associated VTE with HIT. If parenteral anticoagulation is required, argatroban (direct thrombin inhibitor) is the standard. Warfarin should not be started until platelet recovery to avoid warfarin-induced skin necrosis in HIT.

Reference: NICE NG158 VTE diseases; BSH Guidelines for HIT management 2023