ICU SAQs · Haematology / coagulation
HIT — thrombocytopenia with thrombosis on day 7 of heparin
A CICM SAQ on the HIT — the 4T score (the thrombocytopenia, the timing, the thrombosis), the STOP ALL HEPARIN, the argatroban or the bivalirudin, the NO platelets, and the warfarin only AFTER the platelet recovery.
On this page
Study tools
Target exams
CICMFFICMEDIC
Prompt
A 70-year-old post-hip-replacement on the LMWH prophylaxis develops a platelet fall from 250 to 60 on the day 7, and a new DVT. Outline the diagnosis and management.
Question
A 70-year-old post-hip-replacement on LMWH prophylaxis develops a platelet fall from 250 to 60 on day 7, and a new DVT. Outline the diagnosis and management.
References4ShowHide
- [1]Warkentin TE Heparin-induced thrombocytopenia: IgG-mediated platelet activation, platelet microparticle generation, and altered procoagulant/anticoagulant balance in the pathogenesis of thrombosis and venous limb gangrene complicating heparin-induced thrombocytopenia Transfus Med Rev, 1996.PMID 8899954
- [4]Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia Blood Adv, 2018.PMID 30482768
- [21]Cuker A, Gimotty PA, Crowther MA, et al. Predictive value of the 4Ts scoring system for heparin-induced thrombocytopenia: a systematic review and meta-analysis Blood, 2012.PMID 22990018
- [24]Warkentin TE Heparin-induced thrombocytopenia-associated thrombosis: from arterial to venous to venous limb gangrene J Thromb Haemost, 2018.PMID 30099843