silver
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Following abdominal surgery, 48 yr. old woman is administered a drug that potentiates antithrombin III in order to prevent pulmonary embolism. As a consequence of this anticoagulant therapy, she develops thrombocytopenia. The thrombocytopenia is resolved; however, 9 months later this patient presents with unstable angina. Which of the following is indicated to prevent thrombosis?
A. Alteplase
B. Enoxaparin
C. Heparin
D. Filgrastim
E. Bivalirudin
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| Tiff
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E.
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| silver
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hey guys don't forget to write your reason!! 
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| new_n_lost
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E. Bivalirudin
We will give her a heparin alternative cos of previous complications. One would say Choice A is also good but its more expensive and has risks attached to it. So the safer choice with right amount of control is achieved by it.
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| fluoxetin
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E. Bivalirudin
enoxaparin is a low molecular weight heparin, which will also cause heparin induced thrombocytopenia. Alteplase (tPA) is a thrombolytic, not indicated. Filgrastim is the granulocyte colony-stimulating factor, not relavent. Bivalirudin acts as a direct thrombin inhibitor, which rarely causes thrombocytopenia. So, bivalirudin is the best alternative to heparin in this cause.
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| silver
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CORRECT ANSWER: E
Given the heparin-induced thrombocytopenia (HIT) that occurred after the surgery, bivalirudin is now indicated for anticoagulation therapy. Bivalirudin, which is indicated for unstable angina, directly inhibits thrombin and is approved for use in persons with HIT. It forms a compact stoichiometric complex with one molecule of thrombin, neutralizing the actions of thrombin, including thrombin entrapped within previously formed clots. HIT is caused by an IgG autoantibody that reacts with platelet factor 4 (PF4) on the platelet surface and forms a complex with heparin.
Alteplase is a plasminogen activator used as thrombolytic agent in acute MI.
Enoxaparin is a low molecular weight heparin, and heparin both potentiate antithrombin III and are clearly not indicated due to the previous adverse reaction (HIT).
Filgrastim is a recombinant human granulocyte-colony stimulating factor used to treat neutropenia, secondary to cancer chemotherapy.
Since heparin caused thrombocytopenia before, it would be inadvisable to administer again.
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