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. Author manuscript; available in PMC: 2014 Jun 1.
Published in final edited form as: Hematol Oncol Clin North Am. 2013 Apr 13;27(3):541–563. doi: 10.1016/j.hoc.2013.02.001

Table 4. Alternative Anticoagulants for Treatment of HIT.

Argatroban Bivalirudin Fondaparinux
Approval HIT or HIT patients undergoing
PCI with or at risk for HIT		 Patients with or at risk of
developing HIT during PCI		 Has not received FDA approval for use in HIT
Bolus None None N/A
Initial dose for
isolated HIT or
HIT with
thrombosis 		1.5-2 mcg/kg/min100 0.15-0.2 mg/kg/h59 < 50 kg: 5 mg SC daily
50-100 kg: 7.5 mg SC daily
> 100 kg: 10 mg SC daily59
Initial dose for
renal
impairment 		No adjustment necessary126 0.08-0.1 mg/kg/h (CrCl 30-60
mL/min)		 Use with caution if CrCl 30-50 mL/min
0.03-0.05 mg/kg/h (CrCl < 30
mL/min or for patients receiving
renal replacement therapy)109 		Contraindicated if CrCl < 30 mL/min116
Initial dose for
hepatic
impairment 		0.5-1.2 mcg/kg/min100 No adjustment necessary127 No adjustment necessary116
Monitoring Obtain baseline aPTT and 2 hours
after starting infusion126 		Obtain baseline aPTT and 2-3
hours after starting infusion		 Anti-FXa activity can be monitored in renal
insufficiency115
Target aPTT 1.5-3 times the baseline
aPTT. Max goal aPTT=100 sec100 		aPTT 1.5-2.5 times the baseline
aPTT59		 N/A
Dosage
Adjustment
(HIT/HITTS
only) 		Adjust infusion by 0.25-0.5
mg/kg/min to achieve goal aPTT.
Recheck aPTT 2-4 hours after each
dosage change.126 		Adjust infusion by 20-25% to
achieve goal aPTT. Recheck aPTT
2 hours after each dosage change.		 N/A
Maximum dose 10 mcg/kg/min 0.25 mg/kg/h127 10 mg daily116
Transition to
warfarin 		Monitor chromogenic FXa level
while on combined therapy.101 		Monitor INR and/or chromogenic
FXa while on combined therapy.		 Monitor INR while on combined therapy.
Discontinue therapy when INR ≥ 2 for 2
consecutive days116
Chromogenic FXa:102
24-45% (INR 2-3)
15-35% (INR 2.5-3.5)		 Chromogenic FXa:
24-45% (INR 2-3)
15-35% (INR 2.5-3.5)
Confirm INR 4-6 hours after
infusion is stopped
Cost of daily
therapy 107 		$1313 $742 $103
Special
considerations 		No antidote is available126 No antidote is available127 No antidote is available116
HIT in PCI:
0.75 mg/kg bolus followed by a
1.75 mg/kg/h infusion for the
duration of the procedure (all subgroups)
After PCI:
1.75 mg/kg/h (CrCl ≥ 30 mL/min)
1 mg/kg/h (CrCl < 30 mL/min)
0.25 mg/kg/h (hemodialysis)
Optional infusion after PCI 0.2
mg/kg/h for 20 hours127

Not applicable, N/A; creatinine clearance, CrCl; factor Xa, FX