Man With Spontaneous Intracranial Hemorrhage on Therapeutic Enoxaparin, Clopidogrel, and Aspirin

Case Presentation A 65 year-old Caucasian male originally presented to an outside hospital complaining of worsening paroxysmal nocturnal dyspnea, orthopnea, and recent exertional chest pain associated with dyspnea. The patient’s past medical history was significant for coronary artery disease status post coronary bypass, severe aortic stenosis status post bioprosthetic aortic valve repair, congestive heart failure, atrial fibrillation on anticoagulation, dual-chamber pacemaker placement, history of a transient ischemic attack, and type diabetes mellitus. At the outside hospital, coronary angiography revealed occlusion of native vessels and previous grafts. He was considered a poor surgical candidate. He was transferred to Thomas Jefferson University Hospital (TJUH) for a second opinion regarding percutaneous versus surgical intervention.