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.