Journal
AMERICAN JOURNAL OF HEMATOLOGY
Volume 71, Issue 1, Pages 50-52Publisher
WILEY
DOI: 10.1002/ajh.10181
Keywords
heparin-induced thrombocytopenia; deep-vein thrombosis; warfarin; venous limb gangrene; direct thrombin inhibitor
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We report two patients with deep-vein thrombosis complicating immune heparin-induced thrombocytopenia who developed venous limb gangrene during overlapping therapy with a direct thrombin inhibitor (lepirudin or argatroban) and warfarin. In both patients, therapy with the direct thrombin inhibitor was interrupted during persisting severe athrombocytopenia while warfarin administration continued. Both patients exhibited the typical feature of a supratherapeutic international normalized ratio (INRs, 5.9 and 7.3) that has been linked previously with warfarin-associated venous limb gangrene. These data suggest that warfarin anticoagulation be postponed in patients with acute heparin-induced thrombocytopenia until substantial recovery of the platelet count has occurred. (C) 2002 Wiley-Liss, Inc.
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