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Blood & Clots Series: Does my complex patient have DIC?

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

CanMEDS Roles addressed: Expert You are seeing a 56M in your critical care suite who has just arrived as a transfer from a peripheral hospital.  The patient has had a recent diagnosis of acute leukemia and was given chemotherapy and a recent stem cell transplant 20 days ago at this hospital.  When he started getting sicker, they requested a transfer to your site for further management. The patient had a line inserted during …

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Blood and Clots Series: When can patients on direct anticoagulants have surgery?

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

CanMEDS Roles addressed: Professional, Collaborator, Medical expert As a Thrombosis specialist, I am often paged by emergency physicians and orthopedic surgeons requesting anticoagulation reversal in order to facilitate surgery. There are some simple and important points to remember when dealing with this clinical scenario. Case Study It is 8am on Monday morning and you are the orthopedic resident on call today. The night resident asked you to review the 83-year-old woman who presented …

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Blood and Clots Series: My patient has a pulmonary embolism. Should I screen them for cancer?

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

CanMEDS Roles addressed: Expert, Leader An 83 year old female presents for follow-up after completing 3 months of oral anticoagulant therapy with Rivaroxaban for her unprovoked deep vein thrombosis. She did some research online and heard about a link between venous thrombosis and cancer, and asks why you are not getting a CT scan to rule out malignancy. Should you screen her for cancer? If so, which tests are necessary? What is the …

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Blood and Clots Series: What are the risks of reversing DOAC-associated intracranial bleeding?

In Blood & Clots, Medical Concepts by Andrew Shih1 Comment

CanMEDS Roles addressed: Medical Expert Case Description You are seeing a 54F in the emergency department after she sustained a mechanical fall. She struck her head on the pavement and is now confused. Her comorbidities include: hypertension, diabetes mellitus, and atrial fibrillation.  She has been taking rivaroxaban 20 mg daily for three years without incident. Her complete blood count (CBC) demonstrates a white blood cell (WBC) count of 7.9 x 109/L, hemoglobin of …

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Blood and Clots Series: How can I tell whether this patient has a deep vein thrombosis?

In Blood & Clots, Medical Concepts by Kerstin de Wit1 Comment

CanMEDS Roles addressed: Communicator, Collaborator, Scholar, Professional, Medical expert Case Description A patient with increasing pain and edema in his left leg. In a recent hospital admission he was diagnosed with myeloma. This case reviews pretest probability of deep vein thrombosis, D-dimer and interpretation of compression ultrasound. Main Text Last week when I came onto a day shift I was handed over a patient who was waiting for an ultrasound scan. He was …

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Blood and Clots Series: Which antithrombotic therapy should I start for my patient with acute VTE?

In Blood & Clots, Medical Concepts by Eric Tseng7 Comments

CanMEDS Roles addressed: Expert Case Description: You diagnose an 83 year old female patient with an acute DVT. Her comorbidities include hypertension, diabetes, mild chronic kidney disease  (CrCL 55), osteoarthritis, and early mild cognitive impairment for which she is taking Ramipril 10 mg daily, Hydrochlorothiazide 25 mg daily, Metformin 500 mg TID, Donepezil 10 mg daily, and Ibuprofen 200 mg BID. She has no history of coronary artery disease or atrial fibrillation. You …