Coumarin

Oral anticoagulants of the coumarin class (warfarin, phenprocoumon) are not appropriate for therapy of acute HIT (see Chapter 12). HIT patients are at relatively high risk of developing coumarin-induced microthrombosis (venous limb gangrene and skin necrosis syndromes (see Chapter 2). Therefore, coumarin should be delayed until the patient is adequately anticoagulated with danaparoid, lepirudin, or argatroban, and the platelet counts have substantially recovered (usually >150 x 109/L).

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