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

Table 4 Dosage and availability of anticoagulation agents for heparin induced thrombocytopenia syndrome

Drug	Bolus	Dosage	Dosage in renal impairment	Dosage in hepatic impairment	Availability in Australia
Lepirudin	Only if life or limb threatening thrombosis. 0.4 mg/kg iv	0.1-0.15 mg/kg per hour	Cr. Cl. 45-60: 50% of original infusion rate. Cr. Cl. 30-44: 30% of original infusion rate. Cr. Cl. 15-29: 15% of original infusion rate according to body weight. Avoid if Cr. Cl. Lower or use 0.005 mg/kg per hour if on haemofiltration	No change	Discontinued
Desirudin	None	15-30 mg sc bd. Limited data	Not recommended given paucity of data	No change	Not available
Danaparoid	IV according to body weight. < 60 kg: 1500 U; 60-75 kg: 2250 U; 75-90 kg: 3000 U; > 90 kg: 3750 U	400 U/h IV × 4 h followed by 300 U/h IV × 4 h followed by 200 U/h iv	Reduce dose by 30% and monitor antiXa activity	No change	Available
Bivalirudin	None	0.15-0.2 mg/kg per minute	Cr. Cl 10-29: 0.06 mg/kg per minute; Cr. Cl < 10: 0.015 mg/kg per minute iv	No change	Available
Fondaparinux	None	< 50 kg: 5 mg sc; 50-100 kg: 7.5 mg sc; > 100 kg: 10 mg sc	Cr. Cl 30-50: monitor closely. Cr. Cl < 30: Contraindicated	No change	Available
Argatroban	None	2 mcg/kg per minute iv	No change	0.5 mcg/kg per minute	Not available

Cr. Cl.: Creatinine clearance in mL/min; sc: Subcutaneous; iv: Intravenous.