Situation with a thoracic epidural inserted for esophagectomy-that needs to be removed.
POD 3 now: platelets of 59 (baseline 121) , rest of coags normal.
Patient is HIT positive now (was on SQ heparin for DVT prophylaxis ). Has an upper extremity DVT which needs anticoagulation anyways.
Needs argatroban as per HIT protocol and for the DVT .
How would you guys proceed ?
1. Start argatroban , wait for platelet count to rise, stop argatroban in 1-2 days , hold argatroban for few hours and remove the catheter?
or
2. wait to start argatorban , recheck platelet count in 24 hrs and remove epidural before starting argatroban?
POD 3 now: platelets of 59 (baseline 121) , rest of coags normal.
Patient is HIT positive now (was on SQ heparin for DVT prophylaxis ). Has an upper extremity DVT which needs anticoagulation anyways.
Needs argatroban as per HIT protocol and for the DVT .
How would you guys proceed ?
1. Start argatroban , wait for platelet count to rise, stop argatroban in 1-2 days , hold argatroban for few hours and remove the catheter?
or
2. wait to start argatorban , recheck platelet count in 24 hrs and remove epidural before starting argatroban?