Wednesday July 2, 2008

Scenario: You have a patient admitted with confirmed HIT (Heparin-Induced Thrombocytopenia). Patient was started on nonheparin anticoagulant (argatroban). Once platelet count reached a stable plateau and the INR (international normalized ratio) reached the intended target range, for how many days overlap of nonheparin anticoagulation and Coumadin should be continued? - Choose one

A) Switch immediately

B) 2 days

C) 3 days

D) 5 days




Answer: 5 days

According to new (june 2008) American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) on Treatment and Prevention of Heparin-Induced Thrombocytopenia.

"For patients with strongly suspected or confirmed HIT, we recommend against the use of vitamin K antagonist (VKA) [coumarin] therapy until after the platelet count has substantially recovered (usually, to at least 150 x 109/L) over starting VKA therapy at a lower platelet count (Grade 1B); that VKA therapy be started only with low maintenance doses (maximum, 5 mg of warfarin or 6 mg of phenprocoumon) over higher initial doses (Grade 1B); and that the nonheparin anticoagulant (eg, lepirudin, argatroban, danaparoid) be continued until the platelet count has reached a stable plateau, the international normalized ratio (INR) has reached the intended target range, and after a minimum overlap of at least 5 days between nonheparin anticoagulation and VKA therapy rather than a shorter overlap (Grade 1B)".


You can read full guidelines here

Found full range of new ACCP GUIDELINES on ANTITHROMBOTIC AND THROMBOLYTIC THERAPY (8TH ED) here