Nuances of Direct Oral Anticoagulants: Panel Discussion
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Video Transcription
Hello, I'm Stanislav Hankin, the Director of the Vascular Medicine Program at Dartmouth-Hitchcock Medical Center, 11 in New Hampshire.
Today I'm delighted to be joined by two intercoagulation experts, Dr. Craig Beavers, who is a Cardiovascular
Clinical Pharmacist at University of Kentucky College of Pharmacy, and Dr. Theresa Carman, who is the Director of Vascular Medicine at University Hospital Medical Center.
And today we're going to have a nice panel discussion on nuances of direct oral intercoagulants
as part of the practical management of venous thromboembolism, simplifying intercoagulation strategies. Dr. Beavers, Dr. Carman, pleasure to be here with you.
Thank you for having us. Thank you for having me, yeah. These are our disclosures, and we're going to talk about a couple of cases. Let's start off with case number one.
So this is a 63-year-old woman who presents with one week of worsening right calf swelling. Her review of systems is otherwise negative.
Her past medical history is significant for coronary artery disease, status post percutaneous coronary intervention to right coronary artery about three weeks prior to presentation.
She had an endostomy at that time. Additional past medical history is significant for hypertension, hyperlipidemia, type 2 diabetes
mellitus, and then stanchional disease on intermittent hemodialysis. These are her medications listed here include aspirin, amlodipine, atorvastatin, clopidogrel,
isosorbide mononitrate, and metoprolol. Her vital signs are significant for a weight of 135 kilos. Her heart rate is 86. Her blood pressure is normal at 135 or 75.
Her respiratory rate is normal at 18, with normal pulse ox and 99% of room air. On physical examination, she has one plus spinadema of the right calf, and otherwise
normal exam with normal longevity pulses. Her labs are significant for hemoglobin of 14.2, platelets of 250,000, and creatinine of 6.
Video Summary
In this video, a panel of experts discusses the practical management of venous thromboembolism (VTE) and the use of direct oral anticoagulants (DOACs). They discuss two patient cases. In the first case, a 63-year-old woman presents with worsening right calf swelling and is found to have acute venous thrombosis. The panel discusses whether the patient requires hospitalization and the choice of anticoagulant therapy. They also discuss the challenges of managing VTE in patients with end-stage renal disease and the need for regular follow-up and monitoring. In the second case, a 27-year-old woman presents with pleuritic chest pain and is diagnosed with bilateral segmental pulmonary embolism. The panel discusses the possibility of outpatient management for this low-risk patient and the choice of anticoagulant therapy, considering her history of seizure disorder and use of carbamazepine. They also discuss the use of risk scores and testing for antiphospholipid syndrome in VTE management. Overall, the panel emphasizes the need for individualized treatment and a multidisciplinary approach to VTE management.
venous thromboembolism
VTE management
direct oral anticoagulants
patient cases
anticoagulant therapy
end-stage renal disease
follow-up and monitoring
pleuritic chest pain
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