A 68-year-old woman develops heparin-induced thrombocytopenia while hospitalized. She has CKD stage 4 with eGFR 18 mL/min. Which parenteral anticoagulant is the most appropriate choice for bridging?

• A Enoxaparin at reduced dose
• B Argatroban, because it is cleared by the liver and safe in severe renal impairment ✓
• C Fondaparinux at full therapeutic dose without adjustment
• D Bivalirudin, because it undergoes purely renal clearance

Explanation

Argatroban is a small-molecule direct thrombin inhibitor eliminated almost entirely by hepatic metabolism, making it the preferred parenteral agent in HIT complicated by severe renal failure. Fondaparinux is renally cleared and contraindicated below eGFR 30 mL/min, enoxaparin accumulates in renal failure, and bivalirudin is predominantly renally cleared with some enzymatic proteolysis, so all three are poor choices here. Argatroban also raises the INR, relevant if transitioning to warfarin.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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