Age: 54.0
Sex: M
Vaccine: COVID19
Symptoms: Abdominal wall haematoma, Ageusia, Anosmia, Anticoagulant therapy, Anticoagulation drug level above therapeutic
Clinical narrative: 55 y.o. male with history of TOF and Goldenhaar syndrome s/p PVR in 2013 with mechanical AVR/MVR and tricuspid valve repair in 2019 on warfarin, s/p abdominal hernia repair, and COVID recently dx 10/15 presenting with bruising over lower abdomen, mons pubis, and penis.   He reports he started having a cough about 2 weeks ago and was diagnosed with COVID on 10/15. He reports his symptoms were primarily SOB, dry cough, brown, NB diarrhea, rhinorrhea, sore throat, loss of taste and smell. He report feeling hot and cold but hasn't been taking his temperature. He says over the past few days his symptoms have improved though he has residual cough and mucous he is trying to get out. He report he had mild DOE two days ago while bringing stuff in from the house. He denies CP, orthopnea (at baseline 2 pillows), PND, LE edema, weight gain.    He first noticed bruising in his abdomen and mons pubis area spreading down to his penis while taking a shower this AM. He reports pain near the pocket of blood. He denies abdominal pain prior to today. He says he thinks he may have torn the mesh from his hernia repair surgery in May with all of his coughing that may have led to the bleeding today. He reports he has been taking his warfarin as prescribed (7.5mg daily S/M/W/T/F, 10mg on Sat/Tuesday). He denies any new supplementsother than mucinex. OTC. He has not been eating well rece3ntly iso his COVID, though slowly eating more again since Friday. He denies hematuria, blood in his stools, or bleeding anywhere else.    ================================= Hospital Course (10/25-11/3/21) ================================= #Rectus Sheath hematomas #S/p hernia repair  #Supratherapeutic INR  Patient presents with new onset abdominal bruising (inferior to the umbilicus and in the groin suprapubic and surrouding genitalia) found to have INR 6.5 on presentation, which increased to 8.1. BACH was consulted on admission and was following throughout his hospitalization. On HOD 2 was 11.0. On HOD 2 patient was given 1.25 mg PO of vitamin K. On HOD 3 his INR was 2.8 and he was re-started on his home warfarin dose. On HOD 3, on repeat labs his INR was 2.1 and the decision was made to start him on a heparin drip. Patient was likely supratherapeutic secondary to his ongoing underlying infection COVID-19 infection. He tested positive on 10/15/21 and reports decreased appetite for over a week with diarrhea. His rectus sheath hematomas and bleeding in the setting of his productive cough and the underlying fragility of his rectus sheath. INR increased up to 5.8 and then down to 4.7. His bruising continued to improve throughout his admission and his Hgb was stable suggestive of no further abdominal bleeding. INR on discharge was 3.4 and warfarin dose on discharge was 7.5 mg qhs. Plan to recheck INR 1 day after discharge. It will be managed by AMS.   #COVID  #Hx Asthma Tested positive on 10/15/21 for COVID initially with greater fatigue, loss of smell and taste, mild SOB. Symptoms have largely improved and he expresses greatest complaint at this time is ongoing productive cough. Reports improvement in his sxs previously with home inhalers. He required oxygen overnight on multiple occasions and on HOD3  Was started empirically on dexamethasone 6 mg qd per protocol which was discontinued by day of discharge since he was off O2 and doing well.