What is the HIT treatment option?

• A. Unfractionated heparin
• B. Fondaparinux
• C. Warfarin bridging
• D. Argatroban or Bivalirudin

Answer: (D)

In HIT, the priority is to stop all heparin and start a non-heparin anticoagulant that won’t react with HIT antibodies. The antibodies in HIT activate platelets in the presence of heparin, driving thrombosis, so removing heparin is crucial. After stopping heparin, the goal is to prevent further clotting with a drug that directly inhibits thrombin and doesn’t cross-react with the antibodies. Direct thrombin inhibitors fit this need, with argatroban and bivalirudin being the main options. They’re given intravenously, have short half-lives, and their effects can be monitored and adjusted if bleeding occurs. Warfarin isn’t started during active HIT because it can worsen thrombosis and skin necrosis; it’s added later after platelet recovery, often with overlap from a non-heparin agent. Fondaparinux isn’t the first-line HIT treatment due to limited supportive data and monitoring considerations. So the best choice is a direct thrombin inhibitor such as argatroban or bivalirudin.