Page 1 of 1: hey query regarding heparin therapy, please suggest ur answer?

atropine · Credits: 343 My Scrapbook

A 65-year-old woman is admitted to the hospital on Friday night with an episode of squeezing, substernal chest pain that occurred while the patient was watching her favorite TV show. The pain lasted for twenty minutes and was not relieved by nitroglycerin. A dobutamine stress echocardiogram was done a month ago by her private physician, which showed posterior and lateral wall motion abnormalities. Her past medical history is significant for diabetes mellitus.

On arrival at the hospital, an EKG shows ST-segment depression in the lateral leads. She is started on aspirin, nitrates, beta-blockers, and intravenous unfractionated heparin. Three sets of cardiac enzymes are negative. A complete blood count shows a white cell count of 7,800/mm3, a hematocrit of 37%, and a platelet count of 180,000/mm3. The medications are continued, and she is transferred from the cardiac care unit on Sunday evening with plans for a coronary angiography the next day.

On Monday, the patient complains of pain in the right leg. The physical examination is unremarkable, except for moderate right-calf tenderness. The venous Duplex shows thrombosis of the right popliteal vein. Another complete blood count shows: WBC 9,900/mm3, hematocrit 38.8%; and platelets 45,000/mm3. The prothrombin time (PT) is 13.6 seconds, INR 1.0, and partial thromboplastin time (PTT) 68 seconds.

What is your next step in the management of this patient?

(A) Continue unfractionated heparin and start coumadin after the angiogram
(B) Switch unfractionated heparin to low-molecular-weight heparin
(C) Immediately stop heparin and remove heparin-coated catheters
(D) Corticosteroids
(E) Switch unfractionated heparin to lepirudin

2shar · Credits: 7820 My Scrapbook

well i think this is heparin induced thrombocytopenia.so immediately stop heparin n heparin coated cathethers.iam not sure

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