Practice Question
A patient treated for HIT with argatroban is now stable with platelets 210,000/μL. What is the safest next step in long-term anticoagulation?
Answer Choices:
Correct Answer:
Bridge to warfarin only after platelet recovery, or transition to another non-heparin anticoagulant per protocol
Rationale:
◈ Heparin-Induced Thrombocytopenia (HIT) is an immune-mediated reaction where heparin triggers antibodies that activate platelets, causing paradoxical thrombosis despite low platelets.
◈ Once HIT is diagnosed, all forms of heparin (including LMWH) are permanently contraindicated, because re-exposure can cause rapid, severe recurrence and life-threatening thrombosis.
◈ During the acute phase, agents like argatroban (a direct thrombin inhibitor) are used to provide anticoagulation without heparin, protecting the client from clot formation.
◈ After platelet recovery (e.g., >150,000/µL, here 210,000/µL), long-term anticoagulation is often managed by carefully transitioning to warfarin or another non-heparin anticoagulant, following strict protocol to avoid warfarin-induced skin necrosis and ensure overlap coverage.
◈ Stopping all anticoagulation or switching back to heparin or LMWH ignores the ongoing prothrombotic risk after HIT and is unsafe; the patient must remain protected with appropriate, non-heparin long-term anticoagulation.
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This question is from NURSING CONCEPTS II- MIDTERM EXAM FALL 2025 which contains 98 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN Concept-Based Assessment Level Exam(s)
- Answer Choices: 4