Monday April 5, 2010

Case: 54 year old female is admitted to ICU with pulmonary embolism. Patient is started on heparin and has been switched to coumadin (warfarin). Patient platelet count remained low and further workup confirmed HIT (Heparin induced thrombocytopenia). What should be administrated to patient along with initiation of either argatroban or lepirudin?


Answer: Vitamin K (10 mg po or 5 to 10 mg IV)

Warfarin should be postponed until substantial platelet recovery. If warfarin has already been started, vitamin K should be given to reverse the effect of warfarin. Warfarin should be avoided in acute HIT. Warfarin has been associated with worsening venous thrombosis, venous limb gangrene, and/or skin necrosis when used alone or in combination with ancrod in acute HIT. However, warfarin is appropriate for longer term anticoagulation in patients with HIT and thrombosis. Warfarin should be delayed until there is substantial resolution of the thrombocytopenia.



Treatment and Prevention of Heparin-Induced Thrombocytopenia - American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) - CHEST June 2008 vol. 133 no. 6 suppl 340S-380S