Thrombosis Infographic Series: NOACs in VTE

In Infographics, Knowledge Translation, Medical Concepts by Calvin Yeh11 Comments

These infographics are a series of introductory tools for learners in the ED for thrombosis and hemostasis. The goal is to provide a visual guide to the how, when, and why of thrombosis and its treatment in the ED. We will use a mechanistic approach to help you build a conceptual framework to understand how these diseases work.

We will cover:

(1) hemostasis
(2) diseases of hemostasis including thrombo- and hemophilias
(3) antithrombotic treatments and how common agents work,
(4) treatment reversal strategies and how they work,
(5) hemostasis in trauma including fibrinolytics and acquired coagulopathies.

Why were these infographics developed

There are two common ways subspecialty knowledge of new topics in medicine are communicated: (1) word of mouth and experience, and (2) journal articles. Formal journal articles as we all know, are almost always next to useless for communicating the clinical relevance of a topic, and definitely always useless for learners. Experts don’t have a problem reading between the lines because they have experience and prefer these convoluted methods because they allow for communication of a ton of information at one time.

The problem is that this makes for a major barrier for translating new medical advances.

So why not break it down into small manageable pieces for people to digest? This series of tools are being developed because hemostasis and thrombosis is a field that is extremely relevant to the ED, but poorly understood by learners because of the reliance on classical methods of teaching.

Throughout my graduate schooling, I had to come up with easy ways to understand (and remember) all the nitty gritty biochemistry that is required in this field. This series outlines my approach for you which hopefully you’ll find useful. Please feel free to send me any feedback to improve future parts of this series!

NOACs in VTE Infographic:

This infographic is designed to give the ED learner an introduction to the key reasons why new oral anticoagulants are now being used. Due to the controversial status of these drugs, this piece also serves to lay out the major points of discussion as it pertains to the ED.

Click HERE download the complete Infographic (9.9 MB).

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Calvin Yeh

Calvin Yeh

Calvin is a MD/PhD student at McMaster University. Calvin completed PhD studies under Dr. Jeffrey Weitz at the Thrombosis and Atherosclerosis Research Institute. He focussed on the biochemical mechanism and regulation of the coagulation system in the context of anticoagulant drugs including the new (direct) oral anticoagulants.
BoringEM has been 'bringing the boring' to emergency medicine since 2012. In 2016 this Canadian blog brought its content to CanadiEM.
- 3 days ago
  • Taft Micks

    Just some food for thought re: NOACs and AFib…

    In the ROCKET-AF trial, Rivaroxaban was found to be non-inferior to warfarin but those on warfarin were only in the therapeutic range (INR 2 – 3) 55% of the time. In other trials for NOACs, the patients on warfarin were only in the therapeutic range 64-68% of the time. Perhaps we should be working with patients on warfarin to increase their time in the therapeutic range?

    One strategy used in Scandinavian countries is to prescribe warfarin in 1mg tabs and allow the patients to adjust their warfarin dose based on their own point-of-care INR testing. This achieves a greater time in the therapeutic range. However, this requires a very compliant patient and I can’t imagine it’d be fun having to poke yourself everyday/few days but it’s an interesting concept nonetheless.

    • Calvin

      I think it’s a good thought to try to improve TTR for patients on long term warfarin therapy! We’ve long known that better TTR equals more efficacious therapy for example when compared to aspirin for prophylaxis (see Connolly 2008 Circulation PMID 18955670). TTR less than 40% means that warfarin isn’t really much better than aspirin for thrombophrophylaxis, at least in fib.

      The issue is that the TTR numbers in the 55-65% “target” are reported from clinical trials where many centers are specialized thrombosis facilities! This means that the BEST we can hope for, after 60+ years of experience using warfarin is about 65%. In the real world TTR is probably much much less than that

      This is why having a drug that produces the same response in a much wider population is highly sought after. We can avoid under- or over- anticoagulation. Some problems exist of course.. we still don’t know too much about extremes of body weight for example.

  • Simon Althaus

    Fantastic infographics for an overview and very good looking! Thanks for that!
    I miss the reversal option of the “Xabans” with super high doses of prothrombin complex concentrates (30-50 IU/kg) though. This seems to work quite well in studies and our shops routine.
    Keep up the nice work. Looking forward to more 🙂

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  • Congrats to Calvin Yeh for this great piece, which made the LIFTL review #191.

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  • Fernanda Saraga

    Great infographic! Any chance I can use this at a CME program?

    • Brent Thoma


      Everything on the BoringEM website is published under an attribution (you must clearly credit the authors and BoringEM), noncommercial (you can’t sell it or use it to make money), share-alike (if you modify it you need to share it under the same license) Creative Commons license. So yes, you can use it for educational purposes so long as you aren’t profiting from it and attribute it to us!

      Hope that helps 🙂

      Brent Thoma
      BoringEM Editor

      • Fernanda Saraga

        Thanks Brent. I appreciate the information!

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