A 72-year-old woman is brought to the emergency department with severe shortness of breath, tachypnea, and pleuritic-type chest pain. She had
a similar episode 3 weeks ago and has been treated with warfarin since then. The patient has a number of other medical problems and has taken
all of her medications as recommended. On examination, her temperature is 36.7 C (98 F), blood pressure is 120/60 mm Hg, pulse is 118/min,
and respirations are 28/min. Pulse oximetry shows 9396 on room air. Laboratory results are notable for the following:
Coagulation studies
20
Prothrombin time
sec
International Normalized Ratio
(INR)
1.6
The patient's INR is subtherapeutic compared to her target INR range of 2.0-3.0 on warfarin. She is most likely taking which of the following
concurrent medications?
Answers
Answer:
The two most obvious reasons is Pulmonary Embolism and Aortic Dissection in the chest. This is an urgent condition if patient has this.
Explanation:
Symptoms of pulmonary embolism may include shortness of breath or rapid breathing; chest pain; coughing or spitting up blood; anxiety, restlessness, lightheadedness, or rapid heartbeat. Symptoms of deep vein thrombosis include swelling of the leg or leg vein, or leg pain or tenderness, all with a feeling of increased warmth; or red or discolored skin on the leg. About 350,000 to 600,000 patients develop deep vein thrombosis each year, resulting in at least 100,000 deaths per year from pulmonary embolism. A pulmonary embolism is a blood clot that forms in a vein, usually in the calf, travels to the lung, and lodges there. You may have shortness of breath, even while resting, or feel as if you're having a heart attack. It is an emergency, because one large pulmonary embolism or several small ones can be fatal. Blood-thinning medication is the standard treatment. Most people who are treated for pulmonary embolism survive. Those who are older, have an underlying illness, or do not get diagnosed promptly are at greater risk of dying. You are at increased risk for pulmonary embolism or deep vein thrombosis if you have a family history of pulmonary embolism or blood-clotting disorders; have had a pulmonary embolism before; have been bedridden or have had recent surgery or a broken bone; have been sitting or standing for long periods of time (such as on an airplane flight); are pregnant; take birth control pills or hormone replacement therapy; are obese or smoke; or have had cancer, a heart attack, or stroke.