This article provides a discussion of the risk factors, pathogenesis, diagnosis, manifestation, and management of heparin-induced thrombocytopenia from the perspective of critical care nurses. Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug effect that is characterized by platelet activation, hypercoagulability, and a resulting increased risk for thrombosis, both venous and arterial. Summary. Heparin‐induced thrombocytopenia (HIT) is an acquired immune‐mediated hypercoagulability state that is strongly associated with thrombosis. Abstract. We report two patients with deep-vein thrombosis complicating immune heparin-induced thrombocytopenia who developed venous limb gangrene during overlapping therapy with a direct thrombin inhibitor (lepirudin or argatroban) and warfarin. Warfarin treatment of deep venous thrombosis associated with heparin-induced thrombocytopenia is a possible cause of venous limb gangrene, perhaps because of acquired failure of the protein C anticoagulant pathway to regulate thrombin generation. The majority of cases of warfarin-induced venous limb gangrene has been in patients with cancer or heparin-induced thrombocytopenia. However, other hypercoagulable disease states, such as the. To study the pathogenesis of venous limb gangrene associated with heparin-induced thrombocytopenia. Characterization (based on descriptive and case-control studies) of a novel syndrome of limb. CONCLUSIONS: Warfarin treatment of deep venous thrombosis associated with heparin-induced thrombocytopenia is a possible cause of venous limb gangrene, perhaps because of acquired failure of the protein C anticoagulant pathway to regulate thrombin generation. Warfarin is a commonly used anticoagulant that has been associated with several significant cutaneous side effects. The authors report a case of warfarin-induced venous limb gangrene in a patient with presumed antiphospholipid antibody syndrome (APS). The pathogenesis of venous limb gangrene associated with heparin-induced thrombocytopenia. Ann Intern Med 1997; 127:804. Ann Intern Med 1997; 127:804. Srinivasan AF, Rice L, Bartholomew JR, et al. Warfarin-induced skin necrosis and venous limb gangrene in the setting of heparin-induced thrombocytopenia.