A 62-year-old woman on unfractionated heparin for deep vein thrombosis develops a platelet count drop from 280,000 to 90,000 over 5 days. She has new painful cyanosis of the left great toe. What is the most appropriate immediate management?

• A Continue heparin and add warfarin
• B Administer platelet transfusion
• C Switch to low molecular weight heparin
• D Stop all heparin and start a non-heparin anticoagulant such as argatroban ✓

Explanation

This presentation is classic for heparin-induced thrombocytopenia with thrombosis (HITT). All heparin must be stopped immediately, and a non-heparin anticoagulant such as argatroban or fondaparinux must be started because HITT carries a high thrombotic risk. LMWH cross-reacts with HIT antibodies and is contraindicated. Platelet transfusion may worsen thrombosis and is avoided.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.