A 65-Year-Old Man Comes to the Emergency Department Due to Severe

question 369

Multiple Choice

A 65-year-old man comes to the emergency department due to severe right leg pain and is found to have an acute thrombotic occlusion of the right popliteal artery.  He has a history of hypertension, type 2 diabetes mellitus, and hyperlipidemia.  The patient is admitted to the surgical floor and initiated on intravenous unfractionated heparin.  The following morning, he undergoes surgical revascularization of the right leg.  The patient's hospital course progresses well, but 5 days postoperatively his platelet count decreases from 240,000/mm³ on admission to 65,000/mm³.  His vital signs are stable.  The surgical wound is healing well.  There are no rashes or pitting edema.  Which of the following is the most appropriate next step in management of this patient?

• A)Continue heparin and obtain a serotonin release assay
• B)Stop heparin and observe
• C)Stop heparin and order a platelet transfusion
• D)Stop heparin and start argatroban
• E)Stop heparin and start warfarin
• F)Switch to low molecular weight heparin

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