ICU Cases · Haematology & coagulation
The heparin-induced thrombocytopenia — the thrombosis, not the bleeding
A long case on HIT — the 4Ts score, the stop-all-heparin, the argatroban, the warfarin NOT until platelet recovery, and the ELISA/SRA confirmation.
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Prompt
A ventilated patient on heparin VTE prophylaxis develops a platelet drop and a DVT on day 7. Outline the diagnosis and the management.
Presentation
A 65-year-old man, ventilated for 7 days for a pneumonia, is on the enoxaparin 40 mg SC daily for the VTE prophylaxis. On day 7, his platelets have fallen from 280 to 90 x 10^9/L, and he has developed a right femoral DVT. He has no bleeding.[1]
References2ShowHide
- [1]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [2]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.