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2259 Anaesthesia

An 18-year-old previously healthy man is placed on intravenous heparin after having a pulmonary embolism (PE) after exploratory laparotomy for a small-bowel injury following a motor vehicle collision. Five days later, his platelet count is 90,000/mL and continues to fall over the next several days. The patient’s serum is positive for antibodies to the heparin-platelet factor complexes. Which of the following is the most appropriate next management step?

ACessation of all anticoagulation therapy
BCessation of heparin and immediate institution of high-dose warfarin therapy
CCessation of heparin and institution of low-molecular-weight heparin
D. Cessation of heparin and institution of lepirudin
Anaesthesia
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