A 60-year-old man on ICU has been receiving unfractionated heparin for 8 days for DVT prophylaxis. His platelet count has fallen from 250 × 10⁹/L on a...

Question

A 60-year-old man on ICU has been receiving unfractionated heparin for 8 days for DVT prophylaxis. His platelet count has fallen from 250 × 10⁹/L on admission to 85 × 10⁹/L. The 4Ts score is calculated at 6 (high probability). What is the most appropriate immediate action?

Accepted Answer

Stop all forms of heparin and commence a non-heparin anticoagulant (e.g. argatroban or fondaparinux)

Answer

Stop heparin and commence warfarin immediately

Answer

Reduce the heparin dose by 50% and monitor platelet count

Answer

Continue heparin and transfuse platelets

Answer

Stop heparin and observe without alternative anticoagulation

uk-fficm MCQ (SBA): Heparin-Induced Thrombocytopenia

A 60-year-old man on ICU has been receiving unfractionated heparin for 8 days for DVT prophylaxis. His platelet count has fallen from 250 × 10⁹/L on admission to 85 × 10⁹/L. The 4Ts score is calculated at 6 (high probability). What is the most appropriate immediate action?