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Heparin Induced Thrombocytopenia

Even More Swelling

Step 1: View clinicals

A 65 year old woman is admitted for elective replacement of her left knee joint. Her preoperative FBC is as follows: WBC 7,000/mm3, Hb 12 g/dL, platelets 420,000/mm3. An ECG, CXR and fasting plasma glucose are normal. Her medical and surgical histories are unremarkable, and she is not on any drugs. Following an uncomplicated operation, she is started on DVT prophylaxis with subcutaneous enoxaparin. On the 5th postoperative day, she complains of pain and swelling of her left leg.

Step 2: Order all relevant investigations

Full Blood Count

WBC: 8,700/mm3 (4,600-11,000) Hb: 11.9 g/dl (11.5-18) Platelets: 152,000/mm3 (150,000-450,000)

Compression USS L/LL

There is acute thrombosis of the left popliteal vein, with absence of flow and compressibility.


D-Dimer levels are elevated.

PF4 antigen assay

The platelet factor 4 antigen assay is positive.

Step 3: Select appropriate management

Continue Enoxaparin
Start Argatroban
Start Warfarin
Place IVC Filter

Score: ★★☆