Case 1. 61 y/o F presents with a 2-day history of nausea and vomiting. PMH: HTN, endometrial cancer s/p hysterectomy in 2010, heterozygous factor II mutation. Thrombosis history includes PE in 2007, DVTs over 20 years ago. Pt takes apixaban 5 mg BID at home.
Pt diagnosed with metastases to the liver and new bilateral segmental PEs. The patient needs to be taken for a liver biopsy. How will you manage anticoagulation? The antithrombosis pharmacy consulting team was asked to weigh in.
Things to think about regarding anticoagulation: bleed risk of procedure, when to hold and resume anticoagulation surrounding procedure. Risks vs Benefits?
Anticoagulation was held pre-biopsy. The pt now is diagnosed with multiple cerebral infarcts. Will you restart anticoagulation? How?
Neurology ruled out concern for cerebral hemorrhagic conversion. The patient was given x1 dose UFH SQ 6 hours post-procedure. High-intensity UFH gtt started 12-hours post-biopsy without bolus.