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 …

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Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI?

In Blood & Clots, Medical Concepts by Vinai BhagirathLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Main Messages  P2Y12 inhibition is important for the first 1-6 months after PCI insertion, and may have ongoing benefits up to 12 months or longer.  Addition of anticoagulant to antiplatelet therapy increases the risk of bleeding, but reduces the risk of stroke.  Use of an anticoagulant plus P2Y12 inhibitor is preferable to anticoagulant plus dual …

Blood&Clots Series: Performing non-neuraxial bedside procedures on patients taking anticoagulants

In Blood & Clots, Medical Concepts by Calvin YehLeave a Comment

All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert Case Description You are assessing a patient in the emergency room who is presenting with a unilateral large pleural effusion that is causing hypoxia and shortness of breath. She needs a thoracentesis but her INR is 3.0 due to the Warfarin she takes for atrial fibrillation. How can this procedure be performed safely? What about …