The Fellow on Call: The Heme/Onc Podcast New Fellow Bootcamp Series: When Anticoagulation Fails (part 2)
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Jul 3, 2024 Dive into the complexities of anticoagulation failures and discover alternative strategies when conventional treatments falter. Explore the challenges faced by patients on warfarin, including diagnosing new clots and the importance of imaging. Learn about managing anticoagulation in conditions like antiphospholipid antibody syndrome, with a focus on diagnostic testing and INR interpretation. The podcast also emphasizes tailored Lovenox dosing and monitoring drug levels to tackle breakthrough thrombotic events. It's a blend of medical insights and a delightful sandwich shop interlude!
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Dan's Favorite Sandwich Shop
- Dan shared his favorite local sandwich shop that impressed him with house-made ingredients and seasoning.
- He praised their weekly changing menu and highly recommended trying their house-made potato salad.
Case: Clot in APS Patient on Warfarin
- Vivek described a 36-year-old man with antiphospholipid antibody syndrome developing a new clot despite therapeutic warfarin.
- Imaging revealed residual clots rather than a new thrombus, exemplifying the challenge in confirming true anticoagulation failure.
APLS Causes INR Test Interference
- Antiphospholipid antibodies can falsely elevate INR/PT tests, masking true anticoagulation status in APS patients.
- Measuring chromogenic factor X activity provides a more accurate assessment of warfarin effect in this context.