Case: 84-year-old male who presented to hospital with weakness and fatigue. He had ground-level fall in his home one day prior.
He was found in atrial fibrillation with RVR, Hgb 6.1, Hct 18.3, plt 82, NA 129, K 3.9, GFR 27. Cardiac enzymes negative. CXR small left pleural effusion unchanged from previous 2 months earlier, EKG atrial fibrillation, tachycardia HR 130, ST abnormality consider ischemia, poor R wave progression.
PMH: Atrial fibrillation, CVA 5 years ago without residual deficit, COPD, osteoarthritis, BPH.
Medication changed recently changed from warfarin to apixaban due to patient difficulty getting INR tested.
Patient was hospitalized and transfused. GI consult was ordered. Colonoscopy diagnosed lower GI bleed, treated with H2A. Patient was transferred to rehab on ASA 162 mg daily, apixaban discontinued, no other changes to medications.
One week later, patient returns to hospital with similar complaints. Hgb 7.6, Hct 22.8. Recommendation by palliative care physician was hospice. This was not discussed with patient yet.
Thoughts?