Review Question - QID 109791

A 30-year-old man with history of intravenous drug use and methamphetamine-associated chronic thromboembolic pulmonary hypertension (CTEPH) is brought to the emergency department by his girlfriend for worsening abdominal pain and fevers. The patient said the pain was initially around his umbilicus, but he is now experiencing intense tenderness near his groin. He was initially prescribed rivaroxaban, but due to insurance issues, he was switched to warfarin for management of CTEPH 2 weeks ago. His temperature is 102°F (38.9°C), blood pressure is 95/60 mmHg, pulse is 95/min, respirations are 22/min. He states that his blood pressure usually runs low. His physical exam is notable for an unremarkable cardiac exam, bibasilar crackles, and RLQ tenderness with rebound tenderness when the LLQ is palpated. Laboratory results are shown below:

Hemoglobin: 11 g/dL
Hematocrit: 35 %
Leukocyte count: 16,000/mm^3 with normal differential
Platelet count: 190,000/mm^3

Serum:
Na+: 137 mEq/L
Cl-: 100 mEq/L
K+: 3.7 mEq/L
HCO3-: 23 mEq/L
BUN: 40 mg/dL
Glucose: 110 mg/dL
Creatinine: 0.8 mg/dL
Ca2+: 9.1 mg/dL
AST: 34 U/L
ALT: 45 U/L

International normalized ratio (INR): 6.2
Prothrombin time (PT): 40 seconds
Partial thromboplastin time: 70 seconds

Blood type: O
Rhesus: Positive
Antibody screen: Negative

A clinical diagnosis is made and supported by the surgical consult team in lieu of imaging. The next operating room for an add-on procedure will not be available for another 5 hours. Appropriate medical therapy is initiated. What is the most appropriate next step for surgical optimization?