A patient on day 7 of heparin therapy has a platelet count drop from 220,000 to 80,000 over 48 hours and develops a new DVT. The team suspects heparin-induced thrombocytopenia (HIT). Which actions are appropriate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
HIT management: STOP all heparin (including flushes and coated lines), start non-heparin anticoagulation (argatroban or fondaparinux are first-line; warfarin contraindicated until platelets > 150k due to skin necrosis risk), confirm with antibody and functional assays, and lifelong avoidance with documented allergy. Choice 5 is wrong — platelet transfusion in HIT can WORSEN thrombosis; reserve only for active bleeding or pre-procedural needs.
HIT NCLEX traps: (1) "give vitamin K or stop and restart later" — wrong, HIT requires PERMANENT heparin avoidance and immediate alternative anticoagulant; (2) "transfuse platelets to prevent bleeding" — wrong, can worsen thrombosis; (3) "use LMWH instead" — wrong, LMWH (enoxaparin) cross-reacts and is contraindicated. The 4T score (Thrombocytopenia, Timing, Thrombosis, oTher cause) guides empiric treatment.
Patient on day 7 of heparin with platelets 220k→80k over 48 hours and new DVT. 4T score consistent with intermediate-to-high probability HIT. Hematology consulted.
Heparin-induced thrombocytopenia (HIT) — Immune-mediated reaction to heparin causing thrombocytopenia and PARADOXICAL thrombosis; typically days 5-14 of exposure.
4T score — Thrombocytopenia, Timing of platelet fall, Thrombosis, oTher causes; 0-8 score guides empiric treatment.
Argatroban — Direct thrombin inhibitor; first-line non-heparin anticoagulant for HIT; hepatic clearance, monitor aPTT.