Shaswat, A 67-year-old male comes to the physician's office complaining of severe pain in the right foot with paleness of right toe. The patient had a history of receiving unfractionated heparin 7 days back. The hemogram of the patient is as shown below: Hb 13.2 g/dL WBC 10000/mm3 Platelet 50000/mm3 Which of the following should be used to treat this condition?

Heparin induced thrombocytopenia (HIT). Four 'T' in diagnosis of HIT: Venous thrombosis- most common presentation Thrombocytopenia Timing of heparin administration (5-14 days) before developing thrombocytopenia Other causes of thrombocytopenia not evident. Discontinue heparin immediately and LMWH should be avoided DOC for HIT is direct thrombin inhibitors like argatroban. Lepirudin can be used as an alternative Thrombosis is present, This leads to consumption of PROTEIN C, so giving WARFARIN to this patient would fuher decrease PROTEIN C levels and cause skin necrosis. Therefore WARFARIN is avoided in such patients