Hemostasis/Thrombosis   

Would you be comfortable with the use of DOACs?

The WARFASA study suggests some benefit of aspirin in preventing recurrence. Would you consider it only in high bleeding risk patients, or even consid...

For ESRD patients with decreased Protein C activity level, the purported etiology may be a dialyzable substance in uremic plasma that interferes with ...

No DVT. AC started due to extensive size of initial LLE SVT, with continued SVT of contralateral RLE despite therapeutic anticoagulation with apixaban...

New data suggests monoclonal gammopathies can be associated with thrombotic events. Is your practice changing to include monoclonal gammopathy evaluat...

For example, would you consider this method in an ESRD/HD patient with antiphospholipid syndrome who had a major bleed requiring reversal of warfarin ...

Patient has bilateral common, internal, and external iliac and femoral DVT from obstruction by a large uterine mass that is likely malignant and is pl...

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

How often does this occur and does this lower your suspicion for a "true" or clinically significant lupus anticoagulant?

Or do you generally prefer warfarin/non-DOAC agents? Do you consider trialing DOACs and testing anti-Xa DOAC levels to assess for absorption?

vWF and FVIII activities ~200% and were checked because of the patient's family history of "coagulopathy". Is there any utility in repeating the test...

How would you approach anticoagulation in this situation? Does the presence of thrombocytopenia or hemorrhagic splenic infarcts change your manag...

For what duration and is there a preferred anticoagulation agent?

Are there specific guidelines for managing this patient population?

What is your preferred anticoagulation in patients with BMI >50?

Do you do additional workup for venous obstruction or any other different testing/evaluation?

Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs? Do you s...

Confirmatory tests with DRVVT, hexagonal phase assay, and PNP are all normal. No bleeding history

In the setting of requiring anticoagulation for atrial fibrillation and bioprosthetic valve, but also having severe vitamin K deficiency, would you st...

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

Level >60%. No family or surgical h/o of bleeding but heavy postpartum bleeding.

What is the work up and what is the duration of anticoagulation if used?

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer. 

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

Is thrombotic risk too significant? Patient failed OCPs.

(Normal oxygenation and echo)

- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...

APLA syndrome, obesity, non compliance ruled out and prefers another oral anticoagulation. Is higher dose of rivaroxaban or apixaban an option?

If so, what would you consider ordering?

Bleeding disorder such as vWD

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...

Please comment on bridging.

What should be done with a high level?

Please also discuss the type and duration of anticoagulation.

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?

When do you consider initiating eculizumab?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

What if this was "triple-negative" antiphospholipid syndrome?

Especially in a patient without hemophilia or thrombosis history?