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©2013 UpToDate ® Print Email 2012 ACCP recommended treatment of heparin-induced thrombocytopenia (HIT) The following non-heparin agents are recommended for use in acute HIT whether or not complicated by thrombosis : argatroban or danaparoid. Argatroban is suggested over danaparoid in those with renal insufficiency. (Editor's note: Lepirudin is no longer available). In pregnant patients with HIT, the use of danaparoid is suggested over other non-heparin anticoagulants. The use of fondaparinux is suggested only if danaparoid is not available. In patients with antibody-positive HIT who require urgent cardiac surgery, the use of bivalirudin is suggested over other non-heparin anticoagulants. In patients with antibody-positive HIT who require percutaneous coronary interventions, the use of bivalirudin or argatroban is suggested over other non-heparin anticoagulants. Warfarin alone should not be used to treat HIT because of the risk of causing venous limb gangrene and/or skin necrosis. Warfarin is safe to use when it is given to a patient adequately and stably anticoagulated with a drug that reduces thrombin generation (eg, danaparoid, argatroban); it is prudent to delay use of warfarin until the platelet count is >150,000/microL. LMWH should not be given to patients with HIT, whether or not complicated by thrombosis. Prophylactic platelet transfusions should not be administered for the treatment of patients with HIT who do not have active bleeding. ACCP: American College of Chest Physicians; DVT: deep venous thrombosis; LMWH: low molecular weight heparin. Adapted from Linkins LA, et al. Treatment and prevention of heparin-induced thrombocytopenia: Antithrombotic therapy and prevention of thrombosis, 9th edition: American College of Chest Physicians Evidence-based clinical practice guidelines. Chest 2012; 141:e495S.