In anticipation of episode number 36 on anticoagulance, transfusions, and bleeding, I've got with us Dr.

Katerina Povinsky. She's a transfusion medicine specialist hematologist from St. Michael's Hospital in Toronto,

and she's going to tell us her best case ever when it comes to anticoagulance and bleeding. Dr. Pavensky, let it rip.

I got a call from the trauma bay about a patient who was 65 years old following a motor

vehicle collision on one of our major highways, was brought by helicopter to our emergency room, and was being worked on by the trauma team.

As soon as the patient was registered into our system, it became apparent that we have seen this

patient in the past, and in fact, only a year ago he had a mechanical mitral valve implanted

at our hospital. The discharge note also stated that the patient was

discharge on warfarin anticoagulation. Since his injuries were quite severe and he was

actively bleeding while awaiting for his coagulation studies to come back, I received an urgent call

to administer PCC since the assumption was that

the patient was, in fact, on warfarin, and because of significant bleeding, we wanted to

reverse us as soon as possible to allow him to go to the operating room. We checked with the lab,

and for reasons that are unclear at this point, his sample

was not appropriately identified as stat and they did retrieve it and started running the tests.

However, we opted not to wait for the results of the investigation. I issued a dose of PCC at 1,000 international units as a start

while awaiting the results of his coagulation tests. The patient was administered the drug.

He subsequently was transferred to the operating room where he underwent a number of orthopedic procedures,

and he was later transferred to TNICU, where upon awakening, it became apparent that the patient was

not moving the right side of his body. Subsequent imaging revealed that he had a large

left middle cerebral artery stroke.

At the same time, we finally received investigations of his coagulation studies, and his

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