NAPLEX (North American Pharmacist Licensure Examination) Practice Exam

Which injectable anticoagulant is preferred in urgent cardiac surgery or PCI with a history of HIT?

1. Argatroban

2. Bivalirudin (Angiomax)

3. Enoxaparin (Lovenox)

4. Dabigatran (Pradaxa)

The correct answer is: Bivalirudin (Angiomax)

In urgent cardiac surgery or PCI (Percutaneous Coronary Intervention) with a history of Heparin-Induced Thrombocytopenia (HIT), the preferred injectable anticoagulant is Bivalirudin (Angiomax). Bivalirudin is a direct thrombin inhibitor and is commonly used in situations where HIT is a concern due to its mechanism of action. It directly binds to thrombin to inhibit its activity, making it a suitable alternative in HIT patients requiring urgent cardiac procedures. Option A, Argatroban, is also a direct thrombin inhibitor but is primarily used for HIT patients who have renal impairment, as it is metabolized in the liver. Option C, Enoxaparin, is a low molecular weight heparin and is not the preferred option in patients with HIT due to its similarity to unfractionated heparin. Option D, Dabigatran, is a direct oral anticoagulant (DOAC) that inhibits thrombin, but it is not typically used in urgent situations like cardiac surgery or PCI with a history of HIT.