A patient develops HIT type II confirmed by positive PF4 ELISA. Argatroban is chosen over fondaparinux because this patient has severe renal impairment. Which property makes argatroban suitable here?

• A It requires no monitoring because of fixed dosing
• B It can be reversed completely by protamine
• C It is cleared exclusively by hepatic metabolism ✓
• D It inhibits factor Xa without affecting thrombin

Explanation

Argatroban is a direct thrombin inhibitor eliminated almost entirely by hepatic metabolism, so it is safe in renal failure, unlike enoxaparin, fondaparinux and dabigatran which accumulate. It is monitored by aPTT and given as an infusion, so options B and A are false. Fondaparinux would be preferred only if renal function allowed, which is precisely what excludes it here.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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