Benign Hematology   

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.

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?

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...

Patients sometimes ask for annual urinalysis and ultrasound to monitor, but it is unclear if this is indicated.

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

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.

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

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

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)

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...

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...

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...

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.

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...

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

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?

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?