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Heparin-induced thrombocytopenia — RACP Adult Medicine MCQ

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HardHaematologyHeparin-induced thrombocytopeniaRACP Adult Medicine

A 59-year-old man develops a new femoral DVT 7 days after starting unfractionated heparin for acute coronary syndrome. Platelets have fallen from 260 to 86 x10^9/L. There is no sepsis or bleeding. What is the most appropriate management?

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Correct answer: E — Stop heparin and start a non-heparin anticoagulant while testing for HIT

The timing, platelet fall and new thrombosis are highly suggestive of HIT, requiring cessation of all heparin and alternative anticoagulation. Continuing heparin worsens thrombosis risk. Withholding anticoagulation, routine platelet transfusion or aspirin alone is inappropriate.

Reference: Thrombosis and Haemostasis Society of Australia and New Zealand guidance; AMH