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Primary Care

Anticoagulation   

Questions discussed in this category

In extremely obese patients with spontaneous DVT/PE who have been anticoagulated for > 6 months, do you feel comfortable reducing the DOAC to prophylactic dose or do you prefer continuing full dose indefinite anticoagulation?
BMI>40
3 Answers available
How would you manage a patient with SLE that has a remote history of positive anti-phospholipid antibodies with a current DVT and now completely negative APLs?
Would you still plan for lifelong anticoagulation in this scenario? 
1 Answer available
Would you change an elderly, frail patient with atrial fibrillation who is already on a NOAC to VKA treatment?
In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients. 
4 Answers available
Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?
2 Answers available
Would you give transdermal hormone replacement therapy to a woman with remote history of provoked pulmonary embolism?
Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC? 
1 Answer available
In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?
No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen. 
1 Answer available
What would be your approach to a SLE patient who is triple APS positive, has no prior VTE/obstetric events, is stable on HCQ and low dose aspirin, and wants to become pregnant?
2 Answers available
Would you restart prophylactic anticoagulation in a patient with a history of unprovoked PE who received short term anticoagulation with a prior physician?
E.g. low dose DOAC
1 Answer available
Would you use new DOAC loading dose or start with maintenance dosing for a stable patient on existing DOAC who needs to switch brand due to insurance/formulary reasons?
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...
1 Answer available


Papers discussed in this category

Blood Adv,
American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism.
CMAJ,
Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy.
Post reproductive health, 2022 Dec 27
Hormone replacement therapy in women with history of thrombosis or a thrombophilia.
The New England journal of medicine, 2013-02-21
Apixaban for extended treatment of venous thromboembolism.
J Thromb Haemost, 2021 Jul 14
Use of direct oral anticoagulants in patients with obesity for treatment and prevention of venous thromboembolism: Updated communication from the ISTH SSC Subcommittee on Control of Anticoagulation.
The New England journal of medicine, 2017 Mar 18
Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism.
Circulation, 2023 Aug 27
Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial.
Autoimmunity reviews, 2017 Feb 13
Antiphospholipid antibodies disappearance in primary antiphospholipid syndrome: Thrombosis recurrence.
Thrombosis research, 2023 Feb 10
Recurrent thrombotic events after disappearance of antiphospholipid autoantibodies: A long-term longitudinal study in patients with antiphospholipid syndrome.
Lupus, 2017 Mar 29
Cessation of oral anticoagulants in antiphospholipid syndrome.

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