Category Archives: Anticoagulation

Case 74 – summary

Thankyou for your input this week!This week we had a look at a few abnormalities that can be seen on coagulation screens in a pre procedure setting. The first thing to say is there is no replacement for a good … Continue reading

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Case 74 – part 3

We have our 3rd and final case of the week! A 40 year old man who has a vasculitis ,who has been requiring plasma exchange, needs to have a new line put in for exchange. The renal team are concerned … Continue reading

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Case 70 – part 3 – summary

For our last short case this week we looked at a 50 year old gentleman who developed a subdural following an assault. He had been diagnosed with a provoked DVT 1 week prior following knee surgury and had been loaded … Continue reading

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Case 70 – part 3 – the beginning

And for our last case, a 50 year old gentleman has attended A&E following an assault. A CT head has shown a subdural and the neurosurgeons want to take him to theatre. The patient had a knee replacement about 4 … Continue reading

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Case 70 – part 2 – summary

We have a 76 year old gentleman with AF and a recent CVA making him high risk for thromboembolic events.  He was on dabigatran and presented 5 hours after taking his last dose with haematemesis and a perforated DU.  Dabigatran … Continue reading

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Case 70 – part 2 – the beginning

So we now have our second case. A 76 year old gentleman had been admitted under the surgeons with a haematemesis and a perforated duodenal ulcer. The surgeons would like to take him to theatre within the next hour. The … Continue reading

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Case 70 – part 1 – summary

So our patient was a 75 year old male who has a PMH of NIDDM, HTN, AF and a previous bioprosthetic AV replacement. He is anticoagulated for AF with a CHADS2 score of 3 – which is an annual stroke … Continue reading

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Case 70 – part 1 – the beginning

Welcome to our cases this week. This week we will do 3 short cases looking at anticoagulation and perioperative management around elective and emergency surgery. Our first case is a patient who is being seen pre operatively. The patient needs … Continue reading

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Case 58 – summary

We covered a lot of issues this week. Here is a link to the case on Storify: https://storify.com/TeamHaem/case-58-teamhaem-does-dvt Our patient was a 37 year old female with left leg swelling. She had no major medical problems and was on no … Continue reading

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Case 58 – update 4

Our patient has a confirmed left sided DVT. Prior to initiation of anticoagulation a clotting screen is performed. It shows: PT 12s (11-14) APTT 49s (35-40) Fibrinogen 5.5g/L (1.5-4) d-dimer 990ng/mL (<500)   Questions How do you interpret the results? … Continue reading

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Case 58 – update 3

Our patient has a swollen left leg and an intermediate Wells’ score but a positive d-dimer result. She goes on to have an ultrasound of her lower limb. There is debate on whether to do a full leg ultrasound scan … Continue reading

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Case 58- update 2

Our patient has a possible DVT. She has a painful, swollen left leg with some mild erythema. The Wells’ score is 1 and therefore a d-dimer test is required. Had the score been 2 it would be reasonable to move to … Continue reading

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Case 58 – update 1

Thanks for the contributions so far.   We have established that our patient is a 37 year old female and has presented to her general practitioner with a swollen left leg. She had a recent car journey of 90 minutes … Continue reading

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Case 58 – the beginning

Welcome back to TeamHaem. Please read the case below then make some comments/answer the questions on Twitter using #TeamHaem.   A 37 year old female presents to her general practitioner with a swollen leg which has gotten worse over the … Continue reading

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Case 39 – summary

.The final part of our case was dedicated to discussing what tests, if any, should be requested on a patient presenting with an unprovoked VTE (uVTE). Clearly there are many other topics in the field of ‘clots and cancer’ that … Continue reading

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Case 39 – update 2

In the last few days we have established that the 74 year old man with a confirmed DEEP vein thrombosis (in the superficial femoral vein – see this link for discussion of this misnomer: http://jama.jamanetwork.com/article.aspx?articleid=389874). He has had significant indigestion … Continue reading

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Case 39 – update 1

One of the team has written a fantastic summary of differentials and points to consider in the history and examination: thanks olitodd1984! Please see his comments below: Rule out infection– in the history ask about fevers, sweats, rigors, loss of appetite. On … Continue reading

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Case 39 – the beginning

Welcome to case 39, a short case exploring DVT/PE management. Sound dull? Well, we’re going to show you why it’s not just a DVT. This case is particularly aimed at: General medics Surgeons Medical students Nursing students Acute medicine practitioners … Continue reading

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Case 37 part 2 – summary

The key to this mini case was the history. The patient had had numerous previous operations without problems. Therefore inherited bleeding disorder is unlikely. The clotting screen had previously been normal so an acquired problem is what we’re dealing with. … Continue reading

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Case 37 part 2 – update 1

Here are some results that may help: PT 14s (11-14s) APTT 56s (33-40s) Fibrinogen (Clauss) 6.9g/L (1.5-4.5g/L) Thrombin time 38s (15-19) Questions What has happened here? Please reply to us (@teamhaem) on Twitter and always include #teamhaem to allow others … Continue reading

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