Table 3. Characteristics of Anticoagulants Used to Treat Patients with HIT
Characteristic Target
Half-life Elimination
Approved for patients with HITb
Method of administration
Monitoring Effect on INR
Immunologic features
Lepirudin (Refludan®
Thrombin 80 min
) Argatroban Thrombin
40-50 min Renal Hepatobiliary
Treatment Treatment/ PCI
IV, subcut
aPTT, ECT (high doses)
+
40%-60% lepirudin Abc
Antidote available
Crosses placenta
Dialyzable No Unclearf
High-flux dialyzers
IV
aPTT, ACT
+++ None
(Argatroban) Danaparoida (predominantly)
(Orgaran® Factor Xa
24 h Renal Treatment IV, subcut Anti-Xa level 0
reactivity with HIT Abd
5% cross- No
Unclearf 20%
No Nof Yes
) Bivalirudin 25 min
Renal (20%) PCI/
Enzymatic (80%)
cardiac surgery
IV
ECT (high doses)
ACT or aPTT, ++
Potentially cross-
with anti- lepirudin Ab
reactive No
Unclearf 25%
No Yesf
20%
a Not available in the US. b In some countries (check with local health regulatory authorities). c Fatal anaphylaxis has been reported; therefore, patients should be treated only once with this agent. d Clinical significance is uncertain, and routine testing for cross-reactivity is not recommended. e Case reports only. f FDA pregnancy category B.
(Angiomax® Thrombin
)Fondaparinux
(Arixtra® Factor Xa
17-20 h Renal
No subcut
Anti-Xa level
0
May cause HITe
)
