Q:  52 year old female was started on LMWH (low molecular weight heparin) after Right knee replacement. Patient just before discharge complaint of left calf pain and diagnosed with DVT. Patient also noticed to dropped her platelet counts from 256 K/uL to 52 K/ul- and there was a high suspicion of HIT (Heparin induced thrombocytopenia). Patient was started on Argatroban. Your next  step would be to

A) Continue Lovenox till lab confirms the diagnosis of HIT

B) start warfarin for oral transition to anticoagulation

C) Insert IVC filter to prevent PE

D) Discharge patient home on Fondaparinux (arixtra)

E) Continue Argatroban with monitoring of PTT

Answer:  E

HIT is a clinically diagnosis. If clinical suspicion is high, management should be started without waiting for lab results. All Heparin related agents should be discontinued immediately (A is wrong).

Warfarin should not be started till Platelet count is 150 K/ul to prevent warfarin related necrosis. (B is wrong)

IVC filter is not indicated and usually should not be inserted to avoid further complications with thrombus. With Argatroban, patient is already protected for PE (C is wrong)

Patient is too sick to send home with diagnosis of HIT-T (D is wrong)