Problem: M.R. is a 45-year-old woman (weight 75 kg) who presents with a new PE. Her medical history is significant for alcohol abuse, atrial fibrillation, hypertension, seizure disorder, and RA. M.R.'s home drugs include aspirin 81 mg daily, ramipril 10 mg daily, valproic acid 250 mg twice daily, nadolol 20 mg daily, and naproxen 250 mg PO BID. Her baseline laboratory values include: Hgb 14 g/dL, Hct 35%, platelet count 155,000/mm3, and SCr 0.85 mg/dL. M.R. is initiated on a UFH infusion without a bolus.. Which one of the following best describes the potential adverse effect of most concern with UFH heparin therapy in M.R.? Select one: a. heparin induced thrombocytopenia with combined use of valproic acid b. Hyperkalemia with concomitant lisinopril c. Bleeding due to use of an NSAID and heparin d. All of the above