Question

Which of the following drugs is recommended for the treatment of heparin induced thrombocytopenia?

• A. Abciximab
• B. Lepirudin
• C. Warfarin
• D. Alteplase

Hint:

Stop heparin and switch to a direct thrombin inhibitor.

Answer 1

The Correct Option is B

Step 1: Heparin induced thrombocytopenia (HIT) is an immune reaction in which antibodies against the heparin-platelet factor 4 complex cause a falling platelet count and paradoxical thrombosis. Management requires stopping all heparin and starting a non-heparin anticoagulant, classically a direct thrombin inhibitor.

Step 2: Lepirudin is a recombinant direct thrombin inhibitor (a hirudin analogue) that does not depend on or cross-react with heparin. It is recommended for anticoagulation in HIT. So option B is correct.

Step 3: Abciximab (A) is a glycoprotein IIb/IIIa antiplatelet agent used in acute coronary syndromes and during PCI, not for HIT. So A is wrong.

Step 4: Warfarin (C) must not be started alone in acute HIT because it can worsen thrombosis and cause venous limb gangrene by depleting protein C while the patient is still prothrombotic; it is added only later once platelets recover. So C is wrong as the recommended acute treatment.

Step 5: Alteplase (D) is a thrombolytic (tPA) for dissolving established clots in stroke or MI, not the anticoagulant used to manage HIT. So D is wrong.

Conclusion: The recommended drug for HIT is lepirudin, option B.