Q: 58 year old male with mechanical valve mitral valve replacement has 'little rocky course' post operatively in ICU. Patient was managed with IV heparin. Patient is initiated on Warfarin. Last INR was 3.8. Heparin is discontinued but laboratory called this morning with positive OD of 2.4 for 'HIT' (Heparin Induced Thrombocytopenia). Your next action would be?

A) Continue present management with Warfarin

B) Continue Warfarin but increase the INR target

C) Discontinue Warfarin

D) Discontinue Warfarin and start Argatroban

E) Discontinue Warfarin, administer vitamin K and start Argatroban




Answer: E

Warfarin may cause microthrombosis in patients HIT. These patients typically have severe protein C depletion. If warfarin has already been started, vitamin K should be given. Warfarin should not started before the platelet count is above 150.

In above question A and B are wrong as warfarin should be discontinued. C and D are right but not enough. E is the complete answer.