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We present a case of an elderly male with multiple co-morbidities, including atrial fibrillation on warfarin and recently diagnosed left lower extremity deep vein thrombosis (DVT), who presented to the emergency department for dyspnea. He was found to be hypoxic and mildly hypotensive. He was diagnosed with submassive pulmonary emboli (PE) despite having a supratherapeutic international normalized ratio (INR). In this case report, the clinical presentation, diagnostic workup, and management of this patient are discussed.