Explanation: Clopidogrel is an antiplatelet agent and would not be an appropriate agent to use for treatment of venous thrombosis. Rivaroxaban is a new oral direct anti-Xa inhibitor that is still in clinical trials in children. Because this child has thrombosis, continuing heparin while assessing for HIT or using no anticoagulant agent is inappropriate care. HIT antibodies place the patient at high risk of recurrent thrombosis in both venous and arterial circulation. Lepirudin and argatroban, direct thrombin inhibitors, are good alternatives that have been used in children with success. However, this child has evidence of renal insufficiency. Lepirudin is cleared by the kidneys. Therefore, argatroban, which relies on liver metabolism, is the best choice.
Question 5
