New Fellow Bootcamp Series: When Anticoagulation Fails (pt. 1)
Jul 2, 2024
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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!
Verifying the presence of anticoagulant medications through tests like anti-10A levels is crucial for addressing treatment failures.
Patient adherence to anticoagulant regimens is vital, as lapses can lead to serious complications, necessitating thorough medication habit assessments.
Deep dives
Understanding Anticoagulation Failure
Anticoagulation failure is a common issue in internal medicine and hematology, where patients on blood thinners still develop clots. The first step in addressing this failure is to verify if the anticoagulant medication is present in the patient's bloodstream. This can be accomplished through an anti-10A level test, which assesses the presence of drugs like rivaroxaban and apixaban, indicating if they're functioning properly. If undetectable levels are found, it can point to adherence problems or issues with absorption rather than a failure of the medication itself.
The Importance of Patient Adherence
Patient adherence to anticoagulant regimens is critical for their effectiveness, as even slight lapses can lead to serious complications like recurrent clots. Healthcare providers should conduct thorough interviews about medication habits, checking for missed doses or irregular refill patterns, and also consider factors like polypharmacy that might confuse patients. Specific instructions regarding certain medications, such as taking rivaroxaban with food rich in fat for optimal absorption, are essential for preventing non-therapeutic levels of the drug. Understanding barriers to adherence, such as side effects or drug costs, can help providers make adjustments to ensure patients remain on their prescribed medications.
Switching Anticoagulants
If it is determined that a patient has had a true breakthrough clot while on a DOAC, it may be necessary to transition them to alternative anticoagulants like warfarin. Warfarin offers benefits such as the ability to monitor its therapeutic effect through INR levels and may provide a more consistent anticoagulation impact due to its action on multiple clotting factors. In cases where severe anatomic problems are not causing the clotting issue, switching to injectable anticoagulants can also be considered. Ultimately, the choice of anticoagulant depends on patient-specific factors and clinical judgment to optimize treatment outcomes.
An exciting new academic year is about to begin. We know this can be daunting, especially for our newest hematology/oncology fellows. Over the next two weeks, we re-boot some of our high yield episodes you need to know to prepare for your first days as a new fellow and your nights on call.
Next up: When anticoagulation fails, Part 1! [Originally episode 079]