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Heparin-induced thrombocytopenia — RCPSC IM MCQ

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HardHematologyHeparin-induced thrombocytopeniaRCPSC IM

A 70-year-old man receives unfractionated heparin after vascular surgery. On day 7, platelets fall from 240 to 72 x 10^9/L and his leg becomes painful; Doppler ultrasound shows a new femoral DVT. There is no bleeding and creatinine is 90 umol/L. The 4Ts score is high. What is the most appropriate management?

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Correct answer: E — Stop heparin and start therapeutic non-heparin anticoagulation while sending HIT testing

High-probability HIT with thrombosis requires immediate cessation of heparin and therapeutic anticoagulation with a non-heparin agent. Warfarin monotherapy early in HIT is unsafe.

Reference: Thrombosis Canada heparin-induced thrombocytopenia guidance