TABLE 2.
Alternative anticoagulants for patients with HIT II
| Anti- coagulant | Structure | Approx molecular mass (Da) | Mode of action | Half-life | Excretion | Half-life in:
|
Monitoring | Immunological side effects | |
|---|---|---|---|---|---|---|---|---|---|
| Hepatic disease | Renal disease | ||||||||
| Hirudin (lepirudin) | Recombinant protein | 7,000 | Inhibition of thrombin | 90 min | 90% renal | Normal | Prolonged (up to 52 h [55]) | aPTT, ECT | Drug-induced antibodies enhance anticoagulant effect |
| Argatroban | Synthetic peptide | 500 | Direct inhibition of thrombin | 40-50 min | Mainly through liver | Prolonged | Normal | aPTT | None reported so far |
| Danaparoid | Heparinoid (84% heparan sulfate, 12% dermatan sulfate, 4% chondroitin sulfate) | 6,000 | Mainly inhibition of factor Xa, also antithrombin activity | Approx 24 h for factor Xa inhibition and 3 h for antithrombin activity | Mainly renal | Normal | Prolonged | Anti-factor Xa activity | Rarely antibodies to PF4 (without clinical significance) |