Primary Care   

Additional risk factors could be family history of VTE or thrombophilia, such as antithrombin deficiency.

Do you avoid certain IV formulations in this population? Are there special considerations for premedications in this population?

Is there a way to determine a safe time period that allows a patient to fulfill their religious obligations or do you just recommend against fasting?

Primary care providers often check iron studies during workup for fatigue, even if anemia is not present. 

Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?

ACOG 2021 practice guidelines use ferritin >30 ng/mL.

Would your considerations change for a man vs a woman?

Thrombosis of the greater saphenous vein extending from SFJ to mid-calf, unchanged on follow-up Doppler imaging after 3 months of full dose rivaroxaba...

Cardiolipin was mildly positive and persistent after 12 weeks (29->28 MPL). No other significant provoking factors. The patient started on LMWH. W...

The patient takes frequent flights for their job, with no prior history of VTE, and has already been taking measures for prevention including frequent...

Would you anticoagulate for a fixed or indefinite duration? Would you recommend changing her contraception method?

Would you label this as intermediate or high risk and treat with prophylactic or full dose AC? What duration would you treat for?

No prior hx of DVT/SVT. Negative LE doppler. Would you consider anticoagulating and at what dose, or favor close observation?

Are there characteristics which could help identify whether a follicular lymphoma might behave more indolently vs aggressively and inform treatment se...

Would you consider testosterone therapy if he is otherwise asymptomatic?

BMI>40

Assume patient requires anticoagulation in the setting of acute thrombosis, with no need for IVC filter, but is approaching the end of her third trime...

Are the INRs reliable? In what scenarios would you not recommend POC INR use for warfarin monitoring? Are these typically covered by insurance? Are t...

Are there specific safety or efficacy benefits associated with prolonged infusion times in this population?

The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...

Would you still plan for lifelong anticoagulation in this scenario? 

E.g. young male, morbid obesity, with BMI >50 

While follow up ultrasound is not usually recommended in provoked DVT, it often is done either for other reasons or by other physicians. Would this in...

Anemia is secondary to menorrhagia. No gynecologic interventions were possible.

In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients. 

If so, would you start immediately or wait for the second set of labs to confirm before initiating blood thinners?

Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC? 

Is lifelong LMWH the anticoagulant of choice? Would DOACs be an option? 

Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...

No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen. 

The patient has no known history of autoimmune disease.

Would you bridge with enoxaparin 0.7 mg/kg/day in an ESKD patient, as described in a previous retrospective study (Pon et al., PMID: 24718051)?

For example: In a patient presenting with left arm swelling and found to have a left cephalic vein occlusive thrombus on ultrasound

 Should they be placed on routine EGD surveillance and if yes at what intervals?

E.g. pulmonary embolism, portal vein thrombosis, cerebral venous sinus thrombosis

What is the ideal approach for female adolescent athletes if they have complaints of fatigue and dizziness and are diagnosed with mild iron deficiency...

If so, do you treat for a limited period of time or indefinitely?

Since both pregnancy and cancer are risk factors for VTE, is there data to guide when or if we should prophylactically anticoagulate? If so, what shou...

MPN work-up negative

Although testing was not indicated, what do u do with these results? Other hypercoagulability work up negative

E.g. low dose DOAC

Would the answer differ if the index event was arterial vs venous? 

Previous provoking factors resolved (CVC, malignancy, etc)

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

Do you advise against combination OCPs?

If work-up is sent and the patient is found to have a persistently positive antiphospholipid antibody, particularly lupus anticoagulant, would you con...

Currently on nonwarfarin therapeutic anticoagulation

What is the risk of pregnancy loss in absence of anticoagulation? What would you suggest if the patient had anticoagulation in prior pregnancies and r...

The patient has no personal history of VTE, but has positive family history of VTE.  Any prophylactic anticoagulation options? How would manage...

Is it time limited since it may have been triggered by the pregnancy or is it indefinite since it is APLS associated?

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

i.e. long car rides or plane rides

How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?

If so, how long after diagnosis do you do so? 

FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...

Conversion tables suggest starting the new drug with the next dose but do not seem to answer this question (i.e. if switching from rivaroxaban 20 mg d...

i.e. obstretric APS without thrombosis or SLE

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk? 

If so, what agent(s) do you prefer?

What is your duration of anticoagulation?

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

Is there data that it actually helps?

While low-dose aspirin for primary thrombosis prevention in aPL without APS is not typically recommended outside cardiovascular prevention guidelines ...

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

Would appreciate expert opinion on when to reimage and when to restart anticoagulation depending on findings.

If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?

Patient with ferritin level <1000 ng/mL and no evidence of end-organ damage

While there are many factors involving:- type (DVT vs PE, unprovoked vs provoked) and severity of venous thromboembolism (VTE) size- duration of antic...

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

e.g. a genetic mutation picked up through a family member

Do you recommend therapeutic phlebotomy to a certain Hct goal? Any strong evidence for thromboembolic risk related to erythrocytosis or if this is mit...

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients. 

While benefits outweigh known harms and limited data, do you worry about vaccination in patients with a history of or active autoimmune cytopenias (e....

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

AstraZeneca may cause PF4 antibodies leading to vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). 

Assuming the patient is a candidate for all anticoagulation options (no mechanical valve, antiphospholipid syndrome, patient-specific contraindication...

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

While the CKD population is at high thrombotic and bleeding risk, would you consider anticoagulating a patient prophylactically if they had a history ...

Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...

Ref: EINSTEIN-CHOICE and AMPLIFY-EXT Would you approach this differently in patients with inherited thrombophilias?

Are most places administering oral iron as once daily or every other day dosing due to upregulation of hepicidin receptors following oral iron adminis...

There is no uniform guideline in the literature. AAP recommends until 5 years old or 1-year post-splenectomy. Some for 5 years post-splectomy.

In low-risk patients (age < 40) or patients with very obvious causes of blood loss or iron deficiency (menorrhagia, pregnancy), do you routinely pe...

In a patient with a medical or personal indication to induce oligomenorrhea/amenorrhea, how would you manage OCP therapy if a patient develops a VTE d...

If there are a low-risk patients who can be monitored, how would you do so? If unprovoked, would you consider stopping anticoagulation?