Question of the Week

For March 31, 2020

A 42-year-old man with type 2 diabetes and hypertension is hospitalized for treatment of a diabetic foot ulcer while awaiting revascularization of his leg. On the sixth day of hospitalization, routine laboratory tests reveal a platelet count of 75,000 (reference range, 150,000–350,000); the platelet count at admission was normal, at 234,000.

The patient has been afebrile during his hospitalization, with good control of both his blood pressure and blood glucose level. His current medications are ertapenem, metoprolol, morphine as needed for pain, and subcutaneous heparin for thromboprophylaxis.

The patient’s left foot is cooler than his right foot, and he has a clean-base ulcer with bone detectable on probing.

What is the most appropriate therapy while awaiting further laboratory results?

Replace heparin with therapeutic dalteparin
Replace heparin with therapeutic argatroban
Stop heparin; do not add any additional antithrombotic intervention
Replace heparin with use of a sequential-compression device
Replace heparin with warfarin