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1st June 2023
An 81-year-old man presents to A&E following a fall at home where he hit his head
An 81-year-old man presents to A&E following a fall at home where he hit his head.
His past medical history includes AF, for which he has taken warfarin for 7 years (INR target range of 2 – 3), hypertension and CKD. His drug history includes amlodipine and warfarin. He recently tested positive for H.Pylori infection on a stool sample and his GP has started him on a 1-week course of amoxicillin, metronidazole and lansoprazole for H.Pylori eradication.
On examination, his GCS is 14/15 due to confusion, his BP is 146/89 and his HR is 82, irregularly irregular. He has multiple bruises.
CT Head is performed due to confusion and shows an extradural haematoma.
Blood tests are listed below:
| Hb | 115 g/L | Males: (135 – 175 g/L) |
| Platelets | 167 x 10⁹/L | (150 – 400 x 10⁹/L) |
| WCC | 9.6 x 10⁹/L | (4 – 11 x 10⁹/L) |
| Na+ | 137 mmol/L | (135 – 145 mmol/L) |
| K+ | 3.6 mmol/L | (3.5 – 5.0 mmol/L) |
| Urea | 9.2 mmol/L | (2.5 – 6.5 mmol/L) |
| Creatinine | 158 μmol/L | (50 – 120 μmol/L) |
| CRP | 18 mg/L | (0 – 10 mg/L) |
| INR | 6.1 | |
What should be the most appropriate management of anticoagulation?
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