Category Archives: Anticoagulation

Case 93 – summary

This case highlighted a number of issues in the management of VTE. 1) The investigation of a patient with newly diagnosed DVT One of the most useful parts in the history taking is the identification of a provoking factor. We … Continue reading

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Case 93 – update 4

Our patient has had one left leg DVT which was treated with rivaroxaban. He had no symptoms of malignancy. Two months later he presents again with increased leg swelling and pain and has the thrombosis has increased compared to previous. … Continue reading

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Case 93 – update 3

Our patient has his d-dimer checked which is positive and has an ultrasound scan of the left leg which has confirmed a clot. On review of the images the clot is more extensive that previously. This combined with the clinical … Continue reading

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Case 93 – update 2

We discussed what anticoagulant to start in our patient with a newly diagnosed DVT. There are a number of options and the main ones will include: LMWH then warfarin LWMH then dabigatran Rivaroxaban Apixaban LMWH then edoxaban   Various factors … Continue reading

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Case 93 – update 1

Our patient has a confirmed proximal DVT and we recognised the important points in the clinical evaluation by looking for provoking factors: Malignancy Family history Periods of immobility Recent surgery or hospital stays Hormonal therapy or pregnancy Nephrotic syndrome Autoimmune … Continue reading

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Case 93 – the beginning

Welcome to our new #TeamHaem case. You are the acute medicine senior house officer working in ambulatory care. A GP has referred a 58 year old gentleman with left leg swelling and is concerned about deep vein thrombosis (DVT). He … Continue reading

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Case 87 – summary

This week we looked at a case of pulmonary embolism in a lady who was 28 weeks pregnant.   Initial management included: ABC ECG – T wave inversion. S1Q3T3 pattern and right bundle branch block.  May also help with identifying … Continue reading

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Case 87 – the beginning

A 32 year old lady presents to A&E with incresing shortness of breath and chest pain.  She is 28 weeks pregnant. What further information do you need? Initial management/investigations?

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Case 82 – Update 3

Thanks for your continued contributions for this tricky case! We’ve got some new investigations results from what you have requested: Peak anti-Xa levels on re-admission: 0.84. INR 2.2. No evidence of malignancy on recent CTPA / CT abdo pelvis. HIT … Continue reading

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Case 82 – update 2

Our patient continues to deteriorate and the following investigations are now back: Hb 103, Plts 75, WCC 3.4, Neuts 1.6. Blood film: red cell fragments with infrequent spherocytes and polychromasia. Bili 152 (predominantly conjugated), ALT 54, Alk phos 340. Urea … Continue reading

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Case 82 – update 1

Thanks for all the contributions! We now know from the history and investigations requested that: This patient has had no obvious provoking factors for both his previous and current PE – including no symptoms/signs suggestive of autoimmune disorder / maligancy. … Continue reading

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Case 82 – the beginning

Welcome to our new case! A 45 year old gentleman is admitted to the medical assessment unit as he has been diagnosed with a large pulmonary embolus (PE) within the right pulmonary artery. He is requiring 2 litres of oxygen … Continue reading

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Case 81 – summary

Thank you for all the contributions to the case this week. The case We looked at a case of a 58 year gentleman who had an incidental finding of thrombocytopenia, whilst on apixaban therapy. Immediate intervention was required to stop … Continue reading

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Case 81 – update 2

Thankfully the bleeding resolves and no surgical intervention is required The platelet count responds to IVIG, and dexamethasone 40mg given for four days. Any further investigations required?   2 week s following commencement of steroids the platelet count has fallen … Continue reading

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Case 81 – update 1

Our followers have come up with a very comprehensive list of investigations! Our advice/investigation included stopping apixaban Checking Fbc ? Any other abnormalities/previous FBC/ clot in sample  coagulation.  Prolonged PT, normal aptt and fibrinogen renal and liver function HIV, hepatitis … Continue reading

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Case 81 – the beginning

A 58 year old gentlemen has routine bloods taken at the GP surgery.  He is noted to have a platelet count of 38. His doctor rings you as the haematology registrar for advise as he is on apixaban for treatment … Continue reading

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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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