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Answer 4
  1. Start therapy with lepirudin, argatroban, or danaparoid. HITT is life-threatening, and correct management is critical. In addition to stopping heparin, therapy must be initiated with a drug that acts directly on thrombin. Use of warfarin can increase the risk of venous limb gangrene and is not an acceptable option. There are no clinical data to support the use of tissue plasminogen activator therapy. Whereas the risk for HITT is less with LMWH than with unfractionated heparin, cross-reactivity can occur. As a result, LMWH is contraindicated in patients with HITT.

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