How would you approach anticoagulation for a patient with acute bilateral pulmonary emboli related to malignancy, but with a concomitant cavitary lung mass experiencing episodic, small-volume hemoptysis?

This is an interesting question to which we need to apply the art of medicine, weighing the risks and benefits of treatment. The major fatal events in this exact scenario are:

1. Recurrent PE from undertreatment.
2. Sudden massive hemoptysis after aggressive anticoagulation.

The physician's management s...

When people are in hospitals, I have sometimes tried to achieve a lower therapeutic PTT goal, i.e., aPTT between 45-65, to minimize the bleeding while it is still in therapeutic range by IV heparin without Bolus.

In general, any anticoagulation decision is a risk/benefit analysis. This is a patient who definitely needs anticoagulation, but if this is true hemoptysis, the lungs/airway are a "critical site" per ACC expert consensus. Optimization might include addressing the reason for the hemoptysis (treating ...