September 7, 2024

A 70-year-old female with a past medical history of hypertension, coronary artery disease status post 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. Vital signs include BP 90/48, HR 122, T 98.3 F, RR 16, SpO2 97% on room air. The symptoms started roughly this morning and have progressively worsened. She also endorses some abdominal discomfort although the abdominal exam is benign. She appears pale. Lab work is concerning for a hemoglobin of 6.8 g/dl (decreased from 12 g/dl one month prior). She denies any gastrointestinal bleeding, and a rectal exam does not reveal any gross blood.