PMC:7388103 / 7806-9076 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7388103","sourcedb":"PMC","sourceid":"7388103","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7388103","text":"The first step in the management of highly suspected or confirmed HIT is to stop heparin (including heparin flushes), and to initiate a non-heparin anticoagulant, to prevent thrombotic events, in the setting of ongoing massive thrombin generation.4 Available options for anticoagulation include argatroban, bivalirudin, danaparoid, fondaparinux, or a direct oral anticoagulant.6 Argatroban is a reversible inhibitor of thrombin5 with a short half-life and is not renally cleared. It is commonly used in the United States for HIT.4 In 2 multicenter trials of patients with HIT, argatroban resulted in reduced composite endpoint of death, amputation, and thrombosis, when compared with historic controls.5 A major concern with argatroban is potential under-anticoagulation in patients with elevated partial thromboplastin time, secondary to additional coagulopathies (hepatic dysfunction, prior anticoagulation with warfarin, consumptive coagulopathy, and more recently, COVID-19).4 Partial thromboplastin time confounding may also occur in the presence of a nonspecific inhibitor (such as lupus anticoagulant).8 This would increase the risk of thrombosis and limb loss. Data supporting the efficacy of argatroban is limited to patients with suspected or confirmed 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