Which medications are used for prophylaxis and treatment of thrombosis in patients with heparin-induced thrombocytopenia (HIT)?

Updated: Dec 12, 2019
  • Author: Sancar Eke, MD, FASN; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Patients with HIT are at high risk for thrombotic events and should be treated with alternative anticoagulants, typically a direct thrombin inhibitor (DTI). The US Food and Drug Administration (FDA) has approved the DTI argatroban (Acova) for prophylaxis and treatment of thrombosis in patients with HIT. The DTI bivalirudin is approved for use in patients who are undergoing percutaneous coronary intervention (PCI) and have, or are at risk for, HIT or HIT with thrombosis (HITT). The DTI lepirudin was discontinued by the manufacturer in May 2012.

The indirect factor Xa inhibitor fondaparinux (Arixtra) is not approved for use in HIT, but some experts consider it an important treatment option, especially in stable, non–critically ill patients. [54, 57, 58]

Another indirect factor Xa inhibitor, danaparoid, is no longer available in the United States but is used in Canada, Europe, and Australia. The ACCP recommends the use of fondaparinux in pregnant patients with HIT if danaparoid is not available, as this agent does not cross the placenta. [44]

Several novel oral anticoagulants exist (eg, rivaroxaban,dabigatran,apixaban), and preliminary evidence suggests that they may be beneficial for HIT, particularly in cases refractory to standard therapies. [59, 60, 61] However, these agents have not been fully assessed for treatment of patients with HIT and none have FDA approval for use in HIT. [54, 62]

High-dose intravenous immunoglobulin (IVIG) has been used as an adjunct to anticoagulation in patients with HIT. At a usual dose of 1 g/kg for 2 days, IVIG is typically effective in interrupting platelet activation by HIT antibodies and results in a rapid increase in the platelet count. IVIG has also been used to prevent acute HIT when re-exposure to heparin is planned in antibody-positive patients. [63]


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