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17th May 2025
A 65-year-old dialysis-dependent patient for end stage renal disease began taking Warfarin for recurrent arteriovenous fistula thrombosis.
A 65-year-old dialysis-dependent patient for end stage renal disease began taking Warfarin for recurrent arteriovenous fistula thrombosis. After starting Warfarin for 6 weeks, he presented with a net-like pattern of erythematous discolouration on his body, and painful ulcers on his shins.
Investigations:
| Haemoglobin | 106 g/L (130–180) |
| White cell count | 4.8 × 10⁹/L (4.0–11.0) |
| Neutrophil count | 3.9 × 10⁹/L (2.0–7.5) |
| Lymphocyte count | 1.0 × 10⁹/L (1.0-4.0) |
| Eosinophil count | 0.82 × 10⁹/L (0.04–0.40) |
| Platelet count | 500 × 10⁹/L (150–400) |
| INR | 1.7 (<1.4) |
| Serum corrected calcium | 2.45 mmol/L (2.20-2.60) |
| Serum phosphate | 1.86 mmol/L (0.80-1.45) |
| Plasma parathyroid hormone | 24.1 (0.9-5.4) |
| Anticardiolipin IgG antibodies | 28 U/mL (<10) |
| Anticardiolipin IgM antibodies | 35 U/mL (<10) |
What is the most appropriate management?
Select the SINGLE most appropriate option from the list below. Select ONE option only.
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