Hi .Assalam to everybody.Here i need advice from my collegues - TopicsExpress

Hi .Assalam to everybody.Here i need advice from my collegues regarding one case scenario.I have a 55 yrs old lady DM,HTN,ESRD on regular haemodialysis 3 times per week from 1999.She underwent mettalic mitral valve replacement in 2013 and after that recieving warfarin.She presented with extensive necrotic areas over both lower limbs and diagnosed to have calciphylaxis on skin biopsy.During the stay in hospital she underwent extensive debridement after stopping warfarin and putting patient on conventional unfractionated heparin infusion but unfortunately she developed severe thrombocytopenia with suspicion of HIT vs DIC.Now question is how to anticoagulate this patient for her mitral valve.

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