The Curbsiders Internal Medicine Podcast 490: Update! Anticoagulation for Venous Thromboembolism with Dr. Tara Lech, PharmD
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Jul 7, 2025 Joining the discussion is Dr. Tara Lech, Director of Anticoagulation Services at Beth Israel Leahy Health, known for her expertise in developing antithrombotic policies. Dr. Lech dives into selecting and dosing direct oral anticoagulants, emphasizing tailored approaches for different patient populations. She also clarifies the complexities of managing venous thromboembolism, treating failures, and practical tips for anticoagulation during travel. The episode highlights the pharmacist's crucial role in patient education and optimal management.
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Early Anticoagulation and Education
- Start anticoagulation promptly for DVT patients and individualize choices based on renal function and medications.
- Ensure the patient understands medication reasons, schedule, and follow-up for adherence and safety.
Tailor Treatment Duration
- Duration of anticoagulation relies heavily on the nature of risk factors: transient minor versus permanent major.
- Recurrence risk doesn't drop to zero after stopping treatment; ongoing monitoring and patient engagement remain crucial.
Manage Anticoagulation in Pregnancy
- Switch pregnant or conceiving patients from DOACs or warfarin to low molecular weight heparin promptly.
- Engage patients actively about pregnancy plans to avoid fetal risks from unsuitable anticoagulants.