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Blood & Clots Series: What is the role of convalescent plasma for treating COVID-19?

In Blood & Clots, Medical Concepts by Kevin ShopsowitzLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, scholar, advocate Case Description A 45-year-old patient is diagnosed with COVID-19 and is receiving supportive care on the inpatient medicine ward. It is early in her clinical course and she continues to require supplemental oxygen via nasal prongs, but remains in stable condition with mild shortness of breath and intermittent fevers. One day while in …

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Blood & Clots Series: Subsegmental PE – To Treat or Not To Treat?

In Blood & Clots, Medical Concepts by Carolyne ElbazLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, scholar Main Messages   Improved technology has led to an increase in the detection of subsegmental PE (SSPE)   An algorithmic approach can help identify patients who will benefit from anticoagulation: generally those with concomitant DVTs and patients with additional risk factors for progression  There is clinical equipoise regarding the decision to anticoagulate in this case, and …

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Blood & Clots Series: When is it safe to perform neuraxial procedures in an anticoagulated patient?

In Blood & Clots, Medical Concepts by Tobias TritschlerLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Collaborator Case Description You are assessing a 55-year-old male patient in the emergency room who is presenting with headache, fever, and neck stiffness. He needs a lumbar puncture to rule out bacterial meningitis. However, he is on apixaban 5 mg twice daily for atrial fibrillation with a CHADS65 score of 1 point for hypertension. His …

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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), …