The Fellow on Call: The Heme/Onc Podcast New Fellow Bootcamp Series: When Anticoagulation Fails (pt. 1)
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Jul 2, 2024 Discover the intriguing world of anticoagulation as the hosts dive into the challenges of medication failures. They explore case studies illustrating why some patients still encounter blood clots, even while on treatment. Learn about the significance of monitoring drug levels and the impact of patient adherence on therapy success. The conversation also touches on when to pivot to traditional anticoagulants like warfarin, bringing a blend of clinical insights and personal anecdotes to keep the discussions engaging and informative!
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Patient Case of DOAC Failure
- A 52-year-old woman on rivaroxaban for DVT had a new extensive clot in the same leg despite reported adherence.
- She presented with redness, swelling, and fever prompting an ultrasound and hematology consult.
Confirm DOAC Presence First
- Always "prove it" by confirming DOAC presence with an anti-10A level before diagnosing failure.
- Investigate patient adherence thoroughly and order tests before giving additional blood thinners that can confound results.
Assess Patient Adherence and Absorption
- Take a detailed adherence history including missed doses and medication refill habits.
- Assess factors affecting absorption like bypass surgery or taking rivaroxaban without food, as it requires fat for optimal absorption.