DVT with Thrombocytopenia

Here is a case that George heard about on Saturday, May 16. An ultrasound revealed two blood clots in a man’s leg. After two days on Coumadin and Lovenox (LMWH) his platelet count was 4,000/uL so his doctor discontinued the Coumadin. The man had been previously diagnosed with ITP and his doctor wants to arrange for an emergency splenectomy.

My hunch is the Lovenox has caused HIT and he should be switched to argatroban, followed up with a new platelet count, before considering a splenectomy. I realize that HIT usually associates with moderate thrombocytopenia, however I don’t know about HIT in someone with ITP, and would like to hear from some of our expert contributors.