PMC6020481_01
Anti-Xa levels of the patient throughout his hospital admission. LMWH doses are not included as they varied from day to day following the patient's lab results. For reference, the regimen used after September 7 was as follows: <0.35 units/mL: increased dose by 25%, repeat anti-Xa 4 hours after next dose. 0.35-0.49 units/mL: increased dose by 10%, repeat anti-Xa 4 hours after next dose. 0.5-0.59 units/mL: keep same dose, repeat anti-Xa next day. 0.6-1.0 units/mL: contact on call fellow for further recommendations. 1.0-1.5 units/mL: decrease dose by 20%, repeat level before next dose. 1.6-2 units/mL: hold dose for 3 h, then decrease dose by 30%. Repeat level before next dose, then 4 h after next dose. >2 units/mL: hold all doses until anti-Xa is 0.5 units/mL, then decrease dose by 40%. Repeat level before next dose, then q12h until anti-Xa is <0.5 units/mL.
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fig1
Eventually, a steady regimen was found with consistently stable and therapeutic anti-Xa levels (Figure 1).
Coronal CT.
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fig2
A CT of the abdomen and pelvis showed a high-grade small bowel obstruction, with 2 areas of small bowel, suspicious for intussusception (Figures 2 and 3).
Axial CT.
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fig3
A CT of the abdomen and pelvis showed a high-grade small bowel obstruction, with 2 areas of small bowel, suspicious for intussusception (Figures 2 and 3).
Intramural hematoma.
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fig4
Approximately 30 cm of the distal jejunum was found to be tense, heavy, firm, and discolored with a blue hue, with a hematoma that had dissected through the layers of the bowel (Figure 4).