امرأة عمرها ٦٦ سنة بعد جراحة قلب على هيبارين وريدي منذ ٧ أيام. نزلت صفائحها من ٢٤٠ ألف إلى ٩٥ ألف، وتورمت رجلها اليسرى فجأة وصارت مؤلمة. لا يوجد نزيف، والعلامات الحيوية مستقرة. ما التصرف المتوقع؟

A 66-year-old woman after cardiac surgery has been on IV heparin for 7 days. Her platelets fell from 240,000 to 95,000 and her left leg is suddenly swollen and painful. There is no bleeding and vitals are stable. What action is expected?

1. Switch IV heparin to subcutaneous enoxaparin
2. Continue heparin and simply elevate the leg
3. Stop all heparin and start a non-heparin anticoagulant
4. Transfuse platelets to raise the count quickly

Answer: C) Stop all heparin and start a non-heparin anticoagulant. A platelet fall over 50% after 5–10 days of heparin with new thrombosis suggests heparin-induced thrombocytopenia. All heparin stops, including enoxaparin and heparin flushes, and an alternative such as argatroban is given. Platelet transfusion is usually avoided.