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Clinical Problem-Solving
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Volume 344:48-51 January 4, 2001 Number 1
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High Time for Action
Asha R. Kallianpur, M.D., Katherine A. Poehling, M.D., and Robert S. Dittus, M.D., M.P.H.

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A 58-year-old man receiving hemodialysis after failed renal transplantation was admitted with unstable angina. He had a history of hypertension, diabetes mellitus, ischemic heart disease, and transplant-related immunosuppression of several years' duration. Less than four weeks earlier, he had undergone repair of an intraabdominal aortic aneurysm and removal of the renal graft.

Cardiac catheterization was deferred because the prothrombin time and activated partial-thromboplastin time were prolonged, at 88.0 seconds (international normalized ratio [INR], 7.2) and 77 seconds (normal range, 28 to 40), respectively. He reported malaise, fevers, abdominal pain, nausea, and vomiting but no increase in bleeding since the surgery.

. . . [Full Text of this Article]

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From the Divisions of General Internal Medicine and General Pediatrics, Vanderbilt University Medical Center; and the Quality Scholars Program and Tennessee Valley Geriatric Research, Education, and Clinical Center, Nashville Veterans Affairs Medical Center — both in Nashville.

Address reprint requests to Dr. Kallianpur at the Division of General Internal Medicine, S-1121 MCN, Vanderbilt University Medical Center, Nashville, TN 37232-2587, or at asha.kallianpur@mcmail.vanderbilt.edu.

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