Anti-coagulant of choice for heparin induced thrombocytopenia is -

Ans. is 'a' i.e., Lepirudin Heparin induced thrombocytopeniao Heparin induced thrombocytopenia (HIT) results from formation of IgG antibodies to heparin platelet factor 4 complexes. The antibodies then bind platelets and activate them. It results in pro-thrombotic state even in the presence of thrombocytopenia.# HIT usually occurs 5-10 days after exposure to heparins.Management of HITo Stop all forms of heparins and LMW heparins.o Direct thrombin inhibitors (Lepirudin and Argatroban) are anticoagulants of choice.o Lepirudin is safe in liver failure whereas argatroban can be safely administered in anuria (renal failure).o Initially, warfarin causes hypercoagulability, therefore should be avoided.o Lepirudin is continued till platelet count reaches 1,00,000/mL.o Now, warfarin should be started and direct thrombin inhibitors discontinued. Warfarin should be given for at least 30 days.o Fondaparinux can also be used for HIT.