CLINICAL HISTORY 

Two patients were admitted to the hospital at different times during the first quarter of 2002.

Patient #1 History

The first patient was a 69-year-old male admitted for intracranial bleeding. The patient was found at home at the bottom of the stairs, after an unwitnessed fall. Blood pressure at the scene was 240/120. The patient had a past medical history of cerebral vascular accident, chronic obstructive pulmonary disease, hypertension, atrial fibrillation, prostate cancer, skin cancer and type II diabetes mellitus. The patient was on chronic coumadin therapy 2 mg every day. A CT scan demonstrated a left temporal bleed, subarachnoid hemorrhage and small subdural bleed. See Table 1 for admitting laboratory values. 

Patient #2 History

The second patient was an 83-year-old female with a history of hypertension and atrial fibrillation. She was admitted from an outlying hospital with an intracranial bleed. The patient woke up one morning with a headache, nausea and vomiting. She went to her primary care physician and was transferred to an outlying hospital. The patient was on chronic Coumadin therapy because of atrial fibrillation. A CT scan at the outlying hospital demonstrated a cerebellar hemorrhage. The PT was 35 and the INR was 3.4 at this hospital. She was transferred to a tertiary care hospital for further care (See Table 3).