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A critically ill 54-year-old male patient was admitted to our hospital owing to worsening dyspnoea (New York Heart Association (NYHA) class IV). The patient had had severe chronic obstructive pulmonary and ischaemic heart disease with prior myocardial infarction as well as multiple interventions (surgical and percutaneous) owing to carotid and peripheral artery disease. He was receiving oral anticoagulation (international normalised ratio (INR) on admission 1.5) after receiving surgery …