Management of Patients With Acute or Subacute HIT in Special Situations
ÎIn patients with acute HIT (thrombocytopenic, HIT antibody positive) or subacute HIT (platelets recovered, but still HIT antibody positive) who require urgent cardiac surgery, the ACCP suggests the use of bivalirudin over other nonheparin anticoagulants and over heparin plus antiplatelet agents. (2C)
ÎIn patients with acute HIT who require nonurgent cardiac surgery, the ACCP suggests delaying the surgery (if possible) until HIT has resolved and HIT antibodies are negative. (2C)
ÎIn patients with acute HIT or subacute HIT who require percutaneous coronary interventions (PCI), the ACCP suggests the use of bivalirudin (2B) or argatroban (2C) over other nonheparin anticoagulants.
ÎIn patients with acute or subacute HIT who require renal replacement therapy, the ACCP suggests the use of argatroban or danaparoid* over other nonheparin anticoagulants. (2C)
ÎIn pregnant patients with acute or subacute HIT, the ACCP suggests danaparoid* over other nonheparin anticoagulants. (2C)
> The ACCP suggests the use of lepirudin or fondaparinux only if danaparoid* is not available. (2C)
Management of Patients With a Past History of HIT
ÎIn patients with a history of HIT who require cardiac surgery, in whom heparin antibodies have been shown to be absent, the ACCP suggests the use of heparin (short-term use only) over nonheparin anticoagulants. (2C)
ÎIn patients with a history of HIT who require cardiac surgery, in whom heparin antibodies are still present, the ACCP suggests the use of nonheparin anticoagulants over heparin or LMWH. (2C)
ÎIn patients with a history of HIT who require cardiac catheterization or PCI, in whom heparin antibodies have been shown to be absent, the ACCP suggests the use of bivalirudin (2B) or argatroban (2C) over other nonheparin anticoagulants.
ÎIn patients with a past history of HIT who have acute thrombosis (not related to HIT) and normal renal function, the ACCP suggests the use of fondaparinux at full therapeutic doses until transition to a VKA can be achieved. (2C)
ÎIn patients with a past history of HIT who require ongoing renal replacement therapy or catheter locking, the ACCP suggests the use of regional citrate over the use of heparin or LMWH. (2C)
* Not available in the US.
