A patient with heparin-induced thrombocytopenia complicated by acute kidney injury requires parenteral anticoagulation. Which agent is the most appropriate choice?

• A Enoxaparin
• B Bivalirudin
• C Fondaparinux
• D Argatroban ✓

Explanation

Argatroban is a small molecule direct thrombin inhibitor cleared almost entirely by hepatic metabolism, so it remains the preferred parenteral anticoagulant in HIT when renal function is impaired, and no cross-reactivity occurs with HIT antibodies. Enoxaparin is contraindicated in HIT and accumulates in renal failure. Fondaparinux also depends on renal elimination, making it risky here. Bivalirudin is partly renal and less suitable than argatroban in significant kidney injury.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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