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Argatroban and catheter‐directed thrombolysis with alteplase for limb‐ and graft‐threatening thromboses in a patient with a history of HIT

A 73-year-old, 600@, 130 kg, white male who is selfemployed as a farmer presented to the hospital with a chief complaint of severe nausea, vomiting, and diarrhea accompanied by dizziness and diaphoresis occurring since that morning. His family and social history were noncontributory. On examination, the patient appeared comfortable and in no acute distress. The blood pressure was 92/56 mmHg, the pulse 68 beats per minute, the temperature 97.68F, the respiratory rate 18 breaths per minute, and the oxygen saturation 95% on room air. Lung sounds were diminished bilaterally in the bases. The remainder of a 10-point review of systems was negative except for an elevated serum creatinine (1.6, 1.2 mg/dL baseline), BUN (30 mg/dL), and white blood cell count (14.4 K/lL).