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Heparin-induced thrombocytopenia with thrombosis — ABIM Board MCQ

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HardHematology/OncologyHeparin-induced thrombocytopenia with thrombosisABIM Board

A 66-year-old man hospitalized for NSTEMI receives unfractionated heparin. On day 6, platelets fall from 220000/mm3 to 78000/mm3 and he develops new leg pain with ultrasound-confirmed femoral DVT. Which of the following is the most appropriate management?

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

Intermediate or high-probability HIT with thrombosis requires stopping all heparin and starting a non-heparin anticoagulant such as argatroban, bivalirudin, fondaparinux, or a DOAC when appropriate. Warfarin is delayed until platelets recover.

Reference: ASH Heparin-Induced Thrombocytopenia Guideline