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World J Methodol. Jun 20, 2026; 16(2): 113265
Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.113265
Published online Jun 20, 2026. doi: 10.5662/wjm.v16.i2.113265
Comparative effectiveness of parenteral anticoagulants (fondaparinux, argatroban, bivalirudin) in heparin-induced thrombocytopenia: A systematic review
Abdul Rehman, Department of Medicine, Quaid-e-Azam Medical College, Bahawalpur 06318, Punjab, Pakistan
Mehsim Abid, Department of Medicine, Allama Iqbal Medical College, Lahore, 54550, Punjab, Pakistan
Hira Jamil, Inshal Jawed, Department of Medicine, Dow University of Health Sciences, Karachi 74200, Sindh, Pakistan
Sadia Siddique, Department of Medicine, Faisalabad Medical University, Faisalabad 38000, Punjab, Pakistan
Sagar Parkash, FNU Nasrullah, FNU Sapna, Bhawna Lohana, Kiran Lohana, Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Sindh, Pakistan
Mohammad Tufail, Mohammad Sarim Sharaf, Department of Medicine, Sindh Government Hospital, Karachi 75300, Sindh, Pakistan
Co-first authors: Abdul Rehman and Mehsim Abid.
Author contributions: Rehman A, Abid M, Jamil H and Tufail M designed the research study; Siddique S, Prakash S, Nasrullah F performed the research; Sapna F, Lohana B and Sharaf MS contributed new reagents and analytic tools; Lohana K, Jawed I analyzed the data and wrote the manuscript; Rehman A and Abid M played important and indispensable roles in the manuscript preparation as the co-first authors; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest or financial interests related to the content of this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Inshal Jawed, Chief Physician, Senior Researcher, Department of Medicine, Dow University of Health Sciences, Baba-e-urdu Karachi, Karachi 75350, Pakistan.
Received: August 20, 2025
Revised: September 21, 2025
Accepted: December 30, 2025
Published online: June 20, 2026
Processing time: 246 Days and 11 Hours
Revised: September 21, 2025
Accepted: December 30, 2025
Published online: June 20, 2026
Processing time: 246 Days and 11 Hours
Core Tip
Core Tip: Heparin-induced thrombocytopenia is life-threatening and needs alternative anticoagulation. The systematic review included sixteen studies on 2867 patients treated with fondaparinux, bivalirudin and argatroban. None of these agents proved superior, and evidence certainty was low to very low, mainly because most studies were observational and showed heterogeneity. All three agents demonstrated acceptable efficacy and safety; however, treatment choice should be patient specific and clinically informed. Randomized trials are urgently needed to support evidence-based treatment decisions.