Longer Term Anticoagulant Management of the HIT Patient with Thrombosis

Acute HIT by itself is not an indication for longer-term anticoagulation (i.e., 3-6 mo). However, HIT-associated thrombosis, or the underlying disease itself, often is. For longer-term control of thrombosis, oral anticoagulants of the coumarin class (e.g., warfarin or phenprocoumon) are the treatment of choice. However, as discussed subsequently, it is important that coumarin therapy be delayed until there has been substantial recovery in the platelet count. Another option is to avoid coumarin therapy completely, e.g., a patient can be anticoagulated with danaparoid (e.g. 1500 U sc t.i.d. for 4 wk, followed by 1500 U sc b.i.d.). Some physicians have transitioned patients from DTI therapy to sc fondaparinux following platelet count recovery.

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