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Heparin-induced thrombocytopenia with thrombosis — ABIM Board MCQ

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HardHematology/OncologyHeparin-induced thrombocytopenia with thrombosisABIM Board

A 63-year-old man hospitalized for myocardial infarction receives unfractionated heparin. On day 7, platelets fall from 260,000/mm3 to 88,000/mm3 and he develops a new painful swollen left leg. Doppler ultrasound shows proximal DVT. There is no bleeding. Which of the following is the most appropriate management?

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Correct answer: D — Stop heparin and start a non-heparin anticoagulant

Intermediate-to-high probability heparin-induced thrombocytopenia with thrombosis requires stopping heparin and starting a non-heparin anticoagulant such as argatroban, bivalirudin, fondaparinux, or a DOAC depending on acuity and organ function.

Reference: ASH Heparin-Induced Thrombocytopenia Guideline