Abstract
OBJECTIVE: Heparin-induced thrombocytopenia (HIT) is a prothrombotic, immune-mediated complication of heparin therapy. In urgent neuroendovascular procedures, alternative anticoagulation strategies are crucial for mitigating thrombotic risk. Argatroban is a potential substitute; however, its use in neurointervention remains limited. This report describes a case of successful endovascular retreatment using argatroban in a patient with active HIT and includes a literature review to clarify optimal administration protocols, dosages, and monitoring strategies. CASE PRESENTATION: A 77-year-old man with dural arteriovenous fistula (dAVF) developed HIT following initial endovascular embolization. Due to recurrent cortical venous reflux and a high risk of rebleeding, urgent retreatment was performed using argatroban. An intermittent bolus strategy was employed, with dosing adjusted every 30 minutes based on activated clotting time (ACT) to maintain ACT ≥200 seconds. Complete shunt obliteration was achieved without any ischemic or hemorrhagic complications. HIT antibodies became negative 3 months later. CONCLUSION: Argatroban is a viable and safe alternative to heparin in neuroendovascular procedures for patients with HIT. Intermittent bolus administration guided by ACT offers precise, situation-specific control and may be particularly appropriate for hemorrhagic cerebrovascular conditions such as dAVFs.