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Blood & Clots Series: How do I determine if my patient on a DOAC is still at increased risk of bleeding?

In Blood & Clots, Medical Concepts by Matthew Nicholson1 Comment

CanMEDS Roles addressed: Expert Main Messages At standard doses DOACs are safe and effective for most patients and lab monitoring is not required for routine use. If the time of the last dose is known, an estimate of current anticoagulation effect can be obtained by measuring the number of half-lives that have elapsed in those with normal renal function. If the last ingestion is unknown, an estimate of current anticoagulation effect can be …

Blood & Clots Series: What are the risks of reversing anticoagulation?

In Blood & Clots, Medical Concepts by Andrew ShihLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, Communicator Case Description You are working a shift in your local emergency department and an 89-year-old female is brought in with a 2-day history of melena stool.  The patient has a history of atrial fibrillation and uncontrolled hypertension despite being on an ACE-inhibitor. Her initial bloodwork shows a hemoglobin of 102 g/L (no baseline provided), …

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Blood & Clots Series: Is Fecal Occult Blood Testing helpful in deciding whether it’s safe to prescribe anticoagulants?

In Blood & Clots, Medical Concepts by Eric TsengLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert, Leader Case Description You have just diagnosed a 55-year-old male with an acute proximal deep vein thrombosis in the emergency department. The event was unprovoked, and he has symptoms of leg swelling and pain. He is otherwise healthy and takes no regular medications. He has no symptoms suggestive of PE, and his blood pressure and oxygen …

Blood & Clots Series: When and how should I reverse anticoagulation with warfarin?

In Blood & Clots, Medical Concepts by Matthew NicholsonLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description You are in the emergency department seeing an 89-year-old female presenting with five episodes of coffee ground emesis over the last twenty-four hours. She has atrial fibrillation and is on long-term warfarin for stroke prevention. She also has CAD and had two drug eluting stents placed 4 years ago but is no longer …

Blood & Clots Series: How do you stop warfarin for surgery?

In Blood & Clots, Medical Concepts by Kerstin de WitLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Scholar Case Description You are assessing a 76 year old lady who takes warfarin for stroke prevention because she had a mechanical aortic valve replacement 4 years ago. She was at the preoperative clinic this morning because she will have a knee replacement surgery in a weeks time. The anesthesiologist said they would  like to …