An 86-year-old lady was admitted to the intensive care unit (ICU) for atrial fibrillation with rapid ventricular response (Afib with RVR). She has multiple comorbidities, among them, a recent deep venous thrombosis and pulmonary embolism (DVT and PE), for which warfarin was started. Her INR was subtherapeutic and heparin IV is initiated after admission. She is lethargic and barely responsive to stimuli.
Her code status is "do not resuscitate-comfort care arrest" (DNR-CCA). Past medical history (PMH) Abdominal aortic aneurysm (AAA), thoracic aorta aneurysm, deep venous thrombosis and pulmonary embolism (DVT and PE), colon cancer status post (S/P) resection and colostomy, COPD, dementia. Four days after admission, her platelet count decreased in half and blue discoloration of the toes was noted. Laboratory tests results INR - 2.08 PTT - 46.2 Fibrinogen – 459 FSP > 20 D-Dimer Quant -…
