It is likely that new parenteral and oral anticoagulants that selectively target factor Xa or thrombin will increasingly replace heparin and warfarin in the future. As a consequence of this evolution in anticoagulant practice, the use of UFH is likely to decline, resulting in a reduction in the incidence of HIT, and there is likely to be an expansion of the treatment options for HIT. Fondaparinux has an extensive track record as a highly effective and safe parenteral anticoagulant, which is replacing UFH and LMWH across a broad spectrum of clinical indications. Fondaparinux does not cross-react with anti-PF4/heparin antibodies and there are promising albeit limited data supporting its effectiveness and safety for the treatment of HIT. New oral factor Xa inhibitors and oral DTIs are theoretically attractive for the treatment of HIT, but further evaluation is needed for all of these agents.

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