NDLI: Intravenous warfarin and heparin-induced thrombocytopenia: making the diagnosis, management, modern monitoring, and multidisciplinary care.

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Intravenous warfarin and heparin-induced thrombocytopenia: making the diagnosis, management, modern monitoring, and multidisciplinary care.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Burger, Christina F. Schlesinger, Joseph J.
Description	Country affiliation: United States Author Affiliation: Burger CF ( Saint Francis Hospital, Memphis, TN, USA.)
Abstract	OBJECTIVE: To describe the diagnosis, management, and monitoring of a patient with heparin-induced thrombocytopenia (HIT) with thrombosis and simultaneous bleeding risk treated with argatroban and transitioned to intravenous (IV) warfarin secondary to the inability to administer enteral medications. CASE SUMMARY: A 71-year-old man was admitted to the surgical intensive care unit (SICU) following aortic valve repair, coronary artery bypass, and ascending aortic aneurysm repair. On postoperative day 9, he was found to have a pulmonary embolism, and therapeutic heparin was started. The following day, his platelet count was found to have dropped precipitously. HIT was diagnosed, heparin was discontinued, and argatroban was initiated. On postoperative day 22, anticoagulation was discontinued because of massive gastrointestinal bleeding. On postoperative day 35, multiple venous thromboses were found, and argatroban was restarted. The patient developed a high-output enterocutaneous fistula, eliminating the option of enteral route of medication administration. The multidisciplinary SICU team transitioned the patient from argatroban to IV warfarin for long-term anticoagulation. The international normalized ratio was monitored and remained therapeutic throughout his admission without further thrombotic complications. DISCUSSION: HIT occurs when antibodies develop to heparin-platelet factor 4 complexes, causing simultaneous hypercoagulability and thrombocytopenia. It is diagnosed based on both clinical factors and laboratory testing. Treatment includes discontinuation of all forms of heparin; initiation of a nonheparin anticoagulant, such as argatroban; and transition to warfarin. CONCLUSIONS: IV warfarin is a therapeutic option for patients with malabsorption issues. A multidisciplinary team in an intensive care setting optimizes cost-effective, patient-centered, and safe care.
File Format	HTM / HTML
ISSN	10600280
Issue Number	2
Volume Number	48
e-ISSN	15426270
Journal	Annals of Pharmacotherapy
Language	English
Publisher	SAGE Publications
Publisher Date	2014-02-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmaceutical Science Anticoagulants Adverse Effects Heparin Thrombocytopenia Chemically Induced Warfarin Aged Antithrombins Therapeutic Use Cardiac Surgical Procedures Hemorrhage Diagnosis Drug Therapy Humans Infusions, Intravenous Male Pipecolic Acids Pulmonary Embolism Thrombosis Case Reports Journal Article
Content Type	Text
Resource Type	Case study Article
Subject	Pharmacology (medical)

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Intravenous warfarin and heparin-induced thrombocytopenia: making the diagnosis, management, modern monitoring, and multidisciplinary care.

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