A 77-year-old man is admitted to the ICU after a Hartmann’s procedure for fecal peritonitis. He is ventilated and in septic shock. His blood pressure is supported with fluid resuscitation and a norepinephrine infusion. In addition to intravenous antibiotics, his treatment included subcutaneous unfractionated heparin (5000 U twice daily).
The patient’s nurse notes slight bleeding from his abdominal wound and from around his arterial and central venous catheters.
Laboratory test results from that morning include normal LFTs, a Hb of 8.9 g per deciliter, a platelet count of 54,000 per cubic millimeter, an INR of 1.6, an APTT of 52 seconds, and a fibrinogen level of 1.7 g per liter.
We were asked at this point how agressively this mans coagulopathy should be managed.