IS THERE A SAFE WAY TO REVERSE ANTICOAGULATION IN PATIENTS WITH HYPERCOAGULABLE STATE?

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute hip fracture is deemed an emergent orthopedic intervention, such interventions can be complicated if the patient on anticoagulation for chronic thromboembolic disease. We are presenting a case of elderly who presented with acute elevated INR that required rapid reversal, which unfortunately led to fatal event. CASE PRESENTATION: The 80 year-old female PMH DVT, PE, and Factor V Leiden warfarin was admitted management fracture. On presentation, her 4, given vitamin K reversal. Intraoperatively, there were no events. following morning, found less responsive. laboratory studies revealed high anion gap metabolic acidosis secondary lactate indicative bowel ischemia. intubated due worsening mentation. Her CTA abdomen chest significant moderate severe stenosis celiac axis, narrowing splenic, common hepatic artery gastric artery. Unfortunately, she eventually placed in comfort care. DISCUSSION: Any stress including trauma induce systemic inflammation leading increased risk thromboembolism. Immunothrombosis describes activation neutrophils usually triggered by recognition damaged cells, specifically extracellular traps (NETs) their interaction various intracellular proteins triggering coagulation cascade. Therefore, underlying coagulopathy requiring lifelong extreme caution must taken while reversing anticoagulation. CONCLUSIONS: Our underwent replacement surgery after reversal warfarin, however hypercoagulable state recent surgery, suffered from multiple thrombotic events demise. There guidelines provide most appropriate way reverse patients state. 1 out 500 people suffer disease puts them at It imperative develop diseases places ensure safety undergoing surgical procedures. REFERENCE #1: Franchi, T., Eaton, S., De Coppi, P. et al. emerging role immunothrombosis paediatric conditions. Pediatr Res 86, 19–27 (2019). https://doi.org/10.1038/s41390-019-0343-6 #2: Gando, Otomo, Y. Local hemostasis, immunothrombosis, disseminated intravascular traumatic shock. Crit 19, 72 (2015). https://doi.org/10.1186/s13054-015-0735-x DISCLOSURES: No relevant relationships Mary Dickow, source=Web Response Padmini Giri, Zachary Johnson, Verisha Khanam, Sarwan Kumar,