Notes

68 years old male patient S/P IVC FILTER FOR DVT & ON WARFARIN SINCE 6 YEARS covid antigen+ at memon hospital today with fever+ cough 7 days sob today labeled as a case of Protein S/C deficiency with recurrent Hx of DVT in the past (level was sent when the patient was having DVT [ L17854729 PROT-C: 58.3(72-106), APC Resistance:0.93(0.9-2.9), PROTEIN-S: 30.4 (60-110)].
came with high Pt/Aptt cause? = warfarin toxicity / DIC (sepsis/Covid related)

ROC: Need for anticoagulation on Low platelets and covid + patient with thrombophilia. Whether to give cryoprecipitate

Plat count of today is above 50000
have been given warfarin 1 dose on 4/4/21. and Vit K as well reason Reversal of high pt?
can't send any thrombophilia workup; false positive result to be expected if 1-warfarin given {7 days atleast wait is needed off warfarin to send any workup}, 2- DIC {acute thrombotic state}).

PLAN:
May need anticoagulation in the future but not now, as the INR is 4.
Raised pt of 37 could be the likely due to DIC ( low Fibrinogen with raised FDP).
Can start on Enox 60 qd once INR falls below 1.5 then can give (will need to stop if any bleeding develops {possibility is there because of DIC}).
Hold anticoagulation if platelets falls below 50000 ( which is likely in future due to infection), there is already IVC filter in place which will offer some degree of protection until covid resolves.
Send D.dimer stat .
monitor CBC daily for platelets count and INR/fibrinogen once daily, to adjust anticoagulation accordingly.