Lepirudin is used in:-

Management of Heparin Induced Thrombocytopenia (HIT) Stop all forms of heparins and LMW heparins. Do not give platelet transfusions. Direct thrombin inhibitors (Lepirudin and Argatroban) are anticoagulants of choice. Lepirudin is safe in liver failure whereas argatroban can be safely administered in anuria (renal failure). Initially, warfarin causes hypercoagulability, therefore should be avoided. Lepirudin is continued till platelet count reaches 1,00,000/ mL. Now, warfarin should be staed and direct thrombin inhibitors discontinued. Warfarin should be given for at least 30 days. Fondaparinux can also be used for HIT.