What are the alternatives to danaparoid for patients with HIT who have previously been treated with hirudin?
Bivalirudin and argatroban are two alternatives to danaparoid for patients with HIT who have previously been treated with hirudin. Bivalirudin is a 20-amino acid synthetic polypeptide analog of hirudin which binds to the active site of thrombin. It is licensed as an alternative to heparin and is administered as a bolus of 0.75 mg/kg followed by an infusion of 1.75 mg/kg/h for the duration of the procedure. Argatroban is a small molecule competitive inhibitor of thrombin with a molecular weight of 500 kDa. It is used as an alternative to heparin for patients with HIT who require urgent surgery or invasive procedures. It does not require dose adjustments in patients with renal impairment and does not have immunogenic properties. 