The Fellow on Call: The Heme/Onc Podcast Episode 079: Heme Consult Series: When anticoagulation fails, Part 1
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Nov 1, 2023 This podcast discusses the workup for anticoagulation failure, focusing on DOAC failure. They explore challenges and considerations, including verifying blood thinner levels, assessing patient adherence, and exploring anatomic reasons for clot formation. They also discuss alternative anticoagulants like warfarin.
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Case of Apparent DOAC Failure
- A 52-year-old woman on rivaroxaban with prior DVT developed a new clot despite reported adherence.
- Her right leg was red and swollen with ultrasound confirming extensive DVT, prompting hematology consult.
Prove DOAC Failure Before Action
- Always confirm DOAC presence by ordering an anti-10a level before concluding failure.
- This level is binary, showing only whether the drug is in the bloodstream at clot occurrence.
Assess Adherence and Food Intake
- Take detailed medication adherence history including missed doses and refill patterns.
- Counsel patients on rivaroxaban absorption, emphasizing taking it with fatty food for efficacy.