Review: recent advances in argatroban-warfarin transition in patients with heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia is a devastating, life-threatening, immune-mediated complication of therapy with unfractionated heparin, and less frequently, with low molecular weight heparin. Direct thrombin inhibitors are now standard therapy for the prevention of thrombosis in heparin-induced thrombocytopenia. Argatroban, a small synthetic molecule that inhibits thrombin at its active site, is increasingly used as the direct thrombin inhibitors of choice. Transition to longer term oral anticoagulation needs to be instituted after the platelet count has risen, because of the persistent risk of thrombosis. Although guidelines available in the literature outline the management of heparin-induced thrombocytopenia, they are not presented in a concise and comprehensive manner easily followed by physicians. This article reviews current recommendations, relevant studies, and clinical management trials carried out on patients with heparin-induced thrombocytopenia and provides updated, detailed guidelines for treatment of heparin-induced thrombocytopenia with emphasis on a key part of the management, the argatroban-warfarin transition.