Question 25

25.   Your patient is a 53 year old male who was a history of atrial fibrillation presents with an acute thrombotic CVA that is seen on his CT scan of his head with no evidence of bleeding.  He is on coumadin but his INR is only 1.8.   His symptoms began 2 hours prior to arrival when he was eating lunch with his wife that has been with him the entire time.  His NIH stroke scale is 11.  His vital signs are as follows BP 118/62, HR 82, RR-16, Temp 98.0.  He has hot had any recent procedures.  No history of bleeding problems.  His CBC shows his WBC-7.9 Hgb-14.7, Hct-43.0 and Platelets 154,000.  Based upon this data, which is the best treatment option?

A.  Give the patient ASA and admit him to the hospital

B.  Give the patient TPA and admit to the hospital

C.  Start the patient on a heparin drip because his INR is sub therapeutic

D.  Give the patient heparin and plavix.