Step 1 - Hematology/Oncology Questions

USMLE / COMLEX - Step 1 > Hematologic System & Oncology > USMLE/COMLEX 1 - Prep Questions

Q. A 65-year-old man with a history of coronary artery disease is admitted to the hospital for elective coronary artery bypass graft (CABG) surgery. Postoperatively, he is started on heparin for deep vein thrombosis prophylaxis. He develops necrotic skin lesions on the sixth postoperative day at the heparin injection sites. He does not have any other complaints. His laboratory values show a platelet count drop from 220,000/microL to 90,000/microL. His 4Ts score is 6. ELISA is positive for PF4/heparin antibodies. What is the best next step in his management?

Continue heparin therapy and monitor platelet counts daily
Discontinue heparin and initiate direct thrombin inhibitor therapy
Order a platelet transfusion to prevent bleeding complications
Perform a bone marrow biopsy to evaluate for other causes of thrombocytopenia
Transition to low molecular weight heparin (LMWH) for anticoagulation
Log In or Start Your Free Trial
to view the answer.