December 5, 2016

Background: The care of venous thromboembolism (VTE) is currently undergoing a paradigm shift in the US with an increasingly large percentage of patients being discharged home from the Emergency Department (ED).  It wasn’t too long ago that all patients diagnosed with deep vein thrombosis (DVT) and pulmonary embolism (PE) would be admitted for anticoagulation.  Some of the reasons for this were lack of literature to support outpatient therapy in the US, inability to arrange outpatient follow up, and, of course, medicolegal concerns.  Dr. Jeff Kline, one of the thought leaders in VTE, advocates for the outpatient treatment of “low-risk” patients using a modified Hestia criteria supplemented with additional criteria (POMPE-C) for patients with active cancer.  This publication is the initial results of his rivaroxaban-based treatment protocol.

REBEL Review 75: Mechanism of DOACs

Created December 4, 2016 | Hematology and Oncology | DOWNLOAD

April 13, 2016

Today, I gave a lecture on Hemophilia to our residents in San Antonio, TX.  Now this was a core content lecture that I have actually never given before. As I was preparing the lecture I realized that this is a diagnosis that comes up frequently enough that it is important to know about, but also so infrequently that I always have to look up the factor replacement options and calculations.  So instead of being our typical evidence based evaluation of literature, this post will serve as a reminder of the basics of hemophilia and what are the essential elements one needs to know to appropriately treat a patient with Hemophilia.

November 5, 2015

We have written about the new Non-Vitamin K Oral Anti Coagulants (NOACs). Many have jokingly referred to them as the “Noreversabans.” Taking these drugs is a high risk, high reward type of decision. While we recognize the benefits of quick anticoagulation without a need to bridge, as well as being more stable and having less interactions than Coumadin, these drugs are dangerous with serious bleeding concerns. Recently, Dabigatran was likened to “Dancing with the Devil”. For those of us in EM and Critical Care practice, there are no good options for reversing these agents. Once taken there is no turning back… until now?

August 31, 2015

So you are minding your own business working in the ED at Big Hospital, when two dudes (paramedics) bring in a patient with abdominal pain. As luck would have it, this person has a perforated bowel and needs surgery pretty quickly. AND they are on, yes you guessed it… Wait for it… Dabigatran! You consult your local surgeon and she scratches her scrub cap. “I may not want to take that person to surgery? Let me check with my resources and get back…” If you are like me, you are seeing more and more patients on Dabigatran. This drug is touted to be superior to traditional warfarin for reduction of stroke in atrial fibrillation patients (Ruff 2014) and has had a lot of momentum by many other studies.
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