Thrombosis   

Family history is notable for CVA and early onset MI in nonsmokers, but no personal or family history of VTE. APLS testing is negative. Previously fou...

How would you approach anticoagulation in this situation? Does the presence of thrombocytopenia or hemorrhagic splenic infarcts change your manag...

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

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

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?

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

BMI>40

E.g., a patient with newly diagnosed CIDP who is wheelchair-bound.

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...

What is your preferred anticoagulation in patients with BMI >50?

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...

Do you do additional workup for venous obstruction or any other different testing/evaluation?

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

Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...

In the setting of requiring anticoagulation for atrial fibrillation and bioprosthetic valve, but also having severe vitamin K deficiency, would you st...

Is it different than early mobility that we always encourage?

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...

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?  

If so, for how long? 

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

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer. 

Significant history of autoimmune diseases and DVT in family, recent PE/DVT for a month

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. 

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

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

Previous provoking factors resolved (CVC, malignancy, etc)

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

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

- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...

If so, what would you consider ordering?

Should we stop checking factor VIII levels as part of thrombosis workup?

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

How does cirrhosis and/or underlying thrombophilia affect your decision?

What should be done with a high level?

For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...

e.g. in the setting of using prophylactic heparin in the past but now requiring therapeutic anticoagulation

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?

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

Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?

Does having a concurrent consumptive process e.g. DIC change your management? 

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

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

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

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Would you offer this routinely or only if specific complications arise, such as distal emboli?

Would it make a difference if the VTE diagnosis occurs during bevacizumab therapy or whether it preceded the cancer diagnosis?