Anticoagulation for heparin-induced thrombocytopenia before, during, and after peripheral endovascular procedures

Acute heparin-induced thrombocytopenia (HIT) type II requires the immediate discontinuation of heparin and initiation of a non-heparin anticoagulant. Lifelong avoidance of heparin is generally recommended due to the risk of recurrence. Therefore, anticoagulation management in endovascular procedures remains challenging, as heparin is the preferred anticoagulant and evidence on alternative strategies is limited. This narrative review outlines an institutional approach aligned with current guidelines and examines the available data on non-heparin anticoagulants in this setting. Current evidence may support the use of bivalirudin among non-heparin anticoagulants for peripheral endovascular interventions due to indirect evidence of its use during percutaneous coronary intervention in patients with acute HIT. However, bivalirudin is often not available due to drug shortage and not approved for HIT in Europe. This leaves argatroban as the main alternative, particularly in patients with renal impairment. Data on non-heparin anticoagulation for HIT were extrapolated from other types of intervention and from small retrospective studies. In selected cases of patients with remote or subacute HIT B and negative antibodies, intraoperative heparin may be considered if alternative anticoagulants are not practical, particularly in emergency situations, even in this approach is controversial and not discussed in current guidelines regarding peripheral endovascular procedures. In the absence of robust evidence, anticoagulation strategies should be individualized and patients adequately informed. Further studies are necessary to optimize anticoagulant management among patients with HIT undergoing peripheral endovascular interventions.

Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.

Narrative review and institutional algorithm for non-heparin anticoagulation during peripheral endovascular procedures in patients with heparin-induced thrombocytopenia, with focus on bivalirudin and argatroban.

Leech-derived molecules this paper discusses, each with a full profile in the ASH compound registry:

Explore how this research connects to clinical practice

More peer-reviewed studies in Drug Development.

• Novel Leech Antimicrobial Peptides — Hirunipins — Kumar et al. (2025)
• Medicinal Leech Genome Assembly — Anticoagulant Gene Catalog — Kvist et al. (2020)
• Effects of hirudotherapy on liver functions, lipid profile, and insulin sensitivity in rats with metabolic syndrome — Bilden A et al. (2026)
• Hirudotherapy in Medicine and Dentistry — Jha K et al. (2015)
• Medicinal leech therapy (hirudotherapy): a brief overview — Singh A (2010)
• HIRUDOTHERAPY IN PRESBYACUZIS PRAECOX IN CLEAN-UP WORKERS AFTER THE CHORNOBYL ACCIDENT DURING THE POST-CATASTROPHE YEARS — Zabolotnyi D, Mishchanchuk N (2019)
• Investigation of oxidant-antioxidant status in patients treated with hirudotherapy: an experimental study — Sarikan I, Savas H (2024)
• Leech therapeutic applications — Abdualkader A et al. (2013)
• Non-Occlusive Mesenteric Ischemia Due to Hirudotherapy: A Case Report — Akalın Ç, Ekmen N (2020)
• Leech therapy: a history — Hyson J (2005)

Browse all ASH-analysed research →