A client on day 7 of unfractionated heparin for DVT shows a platelet drop from 245 to 95 thousand and a new right-leg DVT extension. Which actions should the nurse anticipate? Select all that apply.

Select All That Apply

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1 Discontinue all heparin including line flushes and LMWH 2 Transfuse platelets to maintain count above 100 thousand 3 Resume warfarin alone once platelets exceed 150 thousand 4 Send HIT antibody (PF4) ELISA and serotonin release assay 5 Initiate argatroban or bivalirudin as a non-heparin anticoagulant

Explanation

HIT is a prothrombotic immune reaction to heparin-PF4 complexes. ALL heparin must be stopped including flushes and LMWH. A non-heparin anticoagulant (argatroban or bivalirudin) is initiated for active or risk-of thrombosis. Confirmatory testing is PF4 ELISA followed by SRA. Platelet transfusion is generally AVOIDED — it fuels thrombosis. Warfarin must NOT be started alone in acute HIT due to protein-C depletion causing skin necrosis and venous limb gangrene; it is added only after platelets recover and overlapped with a non-heparin agent.

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A client on day 7 of unfractionated heparin for DVT shows a platelet drop from 245 to 95 thousand and a new right-leg DVT extension. Which actions should the nurse anticipate? Select all that apply.

Select All That Apply

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