Internal Medicine

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

How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?

2 Answers available

How do you dose apixaban in patients with CrCl <30 mL/minute?

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

How do you manage drug-drug interactions between oral anticoagulants and the ARSI agents such as apalutamide and enzalutamide?

1 Answer available

Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?

In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.

2 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

What are the indications for anticoagulation in splenic infarctions?

What is the work up and what is the duration of anticoagulation if used?

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

Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

1 Answer available

Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?

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

When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?

(Normal oxygenation and echo)

1 Answer available

Would you give antithrombin concentrate for surgical VTE prophylaxis in case of congenital AT deficiency?

1 Answer available

How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?

1 Answer available

What are the alternatives to anticoagulation in an individual with an atrial thrombus and absolute contraindications to anticoagulation?

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

Circulation, 2022 Nov 06

A Randomized Controlled Trial Comparing Apixaban With the Vitamin K Antagonist Phenprocoumon in Patients on Chronic Hemodialysis: The AXADIA-AFNET 8 Study.

Circulation, 2022 Nov 06

Apixaban for Patients With Atrial Fibrillation on Hemodialysis: A Multicenter Randomized Controlled Trial.

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.

Blood, 2014 Oct 15

How I treat splanchnic vein thrombosis.

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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