Heparin induced thrombocytopenia in critically ill: Diagnostic dilemmas and management conundrums

Table 3 Characteristics of alternative anticoagulants

Drug	Route of elimination	Plasma half life	Monitoring	Interaction of antibodies with HITS antibodies	Antidote
Lepirudin	Renal	60 min, up to 200 h in anuric patients[81,82]	aPTT (1.5-2 times baseline) ACT on CPB ECT (Not affected by presence of VKAs or UFH)	None	None ?Haemofiltration[47]
Desirudin	Renal	2-3 h	None	None	None
Danaparoid	Renal	24 h	Anti-Xa activity (0.5-0.8 U/mL)	Possible, but very rare	None
Argatroban	Hepatic	40-50 min	aPTT (1.5-3 times baseline) ACT on CPB	None	None
Bivalirudin	Enzymatic 80% (Thrombin), renal 20%	25 min	aPTT (1.5-2.5 times baseline) ACT on CPB	None	None ?Haemofiltration[52]
Fondaparinux	Renal	17-20 h	None, Anti Xa levels with renal impairment	Case reports only[45,61,62]	None

aPTT: Activated partial thromboplastin time; ACT: Activated clotting time; ECT: Ecarin clotting time; CPB: Cardiopulmonary bypass; HITS: Heparin induced thrombocytopenia syndrome; UFH: Unfractionated heparin.