ABSTRACT
The topic, “Treatment of Heparin-Induced Thrombocytopenia,” befits a book entitled New Therapeutic Agents in Thrombosis and Thrombolysis. This is because the two most widely used anticoagulant classes-heparins and coumarins-are usually considered to be contraindicated for use during the acute (thrombocytopenic) phase of immune heparininduced thrombocytopenia (HIT) (1). Furthermore, HIT confers an exceptionally high risk of venous and/or arterial thrombosis (odds ratio for thrombosis, 20 to 40) (2,3), even if the inciting agent-heparin-is stopped (4). Thus, most patients with HIT require treatment with an alternative, non-heparin anticoagulant with rapid onset of action. Indeed, two direct thrombin inhibitors (DTIs), lepirudin and argatroban, were introduced into the pharmacologic armamentarium through their approval for management of HIT (5).
