# A client with acute HIT is receiving argatroban. The platelet count is 82,000/mm3 and rising. Which new prescription should the nurse clarify?

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> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with acute HIT is receiving argatroban. The platelet count is 82,000/mm3 and rising. Which new prescription should the nurse clarify?

## Option

1. Continue the authorized non-heparin anticoagulant
2. Begin warfarin today before platelet recovery **✔ Correct answer**
3. Trend platelet count and assess for thrombosis
4. Review hepatic function for argatroban dosing

**Correct answer: 2**

## Explanation

Warfarin should not be initiated during acute HIT before platelet recovery because early VKA therapy can worsen the prothrombotic state.

## In-depth explanation

Quick answer
Clarify early warfarin initiation before platelet recovery.

Why this is correct
ASH guidance recommends a non-heparin anticoagulant in acute HIT and delaying VKA initiation until platelet recovery. Transition also requires careful overlap and INR interpretation.

Easy analogy or mental picture
Do not remove the remaining natural anticoagulant support while the HIT clotting fire is still active.

Memory hook
Acute HIT: non-heparin first; warfarin after platelet recovery.

NCLEX decision rule
Use the phase of HIT and platelet trend to judge transition safety.

Why the other choices are wrong
Continuing argatroban, monitoring platelets and thrombosis, and checking hepatic function support the current safe regimen.References
1ASH Guideline: Heparin-Induced ThrombocytopeniaAvoiding early VKA initiation and waiting for platelet recovery before transition

## Clinical scenario

HIT transition check
Verify platelet recovery, thrombosis status, non-heparin agent, organ function, overlap plan, INR interpretation, and all heparin avoidance.

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