USMLE Step 3 Quiz
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PULMONOLOGY
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A 61-year-old man is discharged 3 days ago after PE provoked by trauma and immobilization. He is on warfarin with enoxaparin bridge; target INR 2.0–3.0. He returns with mild hemoptysis and extensive ecchymoses on arms. Vitals stable. Labs: INR 4.2, Hgb 13.0 g/dL, platelets 220k, creatinine 1.6 mg/dL (eGFR 44 mL/min/1.73 m²). He has continued enoxaparin injections because he misunderstood instructions. Based on the scenario, what adjustment, if any, should be made to the patient's anticoagulation therapy?
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