HIT (Heparin-Induced Thrombocytopenia) Form

HIT Algorithm:

Full anticoagulation with argatroban / lepirudin until platelet count rises above 150,000/uL


– synthetic analogue of L-arginine

-reversibly binds active site of thrombin

– rapid onset, given by drip

– goal is PTT 1.5-3x control

– cleared by liver

– ok to use in renal insufficiency (no dose adjustment)


– recombinant form of hirudin (anticoagulant in leech saliva), binds irreversibly to thrombin

– given as drip

– give bolus i life-threatening thrombosis

– goal: PTT 1.5-3x control

– cleared by kidneys.

– re-exposure can produce life-threatening anaphylaxis: ONE TIME TREATMENT ONLY


Start coumadin for long-term anticoagulation if HIT associated with thrombosis.

Do not start coumadin until platelet count increases >150,000/uL.

Initial dose of coumadin should not exceed 5mg. (Reduce risk of limb gangrene during active phase of HIT)

Continue antithrombin agents until coumadin achieves full anticoagulation


Kiwon Lee NeuroICU Book.

(Marino, 2014)


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