Background: Patients with end stage renal disease (ESRD) are at significantly increased risk for both thrombosis and bleeding relative to those with normal renal function, which makes anticoagulation particularly challenging. Evidence suggests that rivaroxaban and dabigatran are associated with a higher risk of bleeding in ESRD patients. To date, no large national cohort studies have […]

Background: Multiple factors can lead to overuse of diagnostic imaging for venous thromboembolism (VTE). These include fear of missing a potentially fatal diagnosis, low predictive accuracy of clinical gestalt, prediction rules, and risk assessment models for VTE, and increased access to imaging. Diagnostic imaging for deep venous thrombosis (DVT) with doppler ultrasonography, or for pulmonary […]

Background: International VTE management guidelines recommend outpatient management for appropriate patients with low-risk deep vein thrombosis (DVT) or pulmonary embolism (PE)[1-3]. Despite the evidence and recommendations, previous studies reported low prevalence of outpatient management, especially for PE[4, 5]. This analysis aimed to characterize trends in outpatient vs. inpatient management of VTE in the last 5 […]

Case Presentation: A 54-year-old female with essential hypertension, hyperlipidemia, hypothyroidism and MGUS presented to Wheeling Hospital complaining of weakness, dyspnea on exertion and right lower extremity pain for two weeks. Patient was treated for a right gastrocnemius DVT, acute SARS-CoV-2 pneumonia and pulmonary emboli in right middle and lower lobe pulmonary artery branches with smaller […]

Background: Acutely ill hospitalized medicine patients are at increased risk for venous thromboembolism (VTE) and chemoprophylaxis of VTE is recommended for this patient population. Agents typically used for VTE chemoprophylaxis include unfractionated heparin and low molecular weight heparin (LMWH) administered via subcutaneous injection one to three times daily. Over the past decade, new evidence is […]

Background: Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in the hospital setting. While respiratory symptoms are the fundamental feature of COVID-19 infection, VTE is a known sequelae given the hypercoagulable state of the disease. Therefore, it is common for hospitalists to prescribe prophylactic anticoagulation in the inpatient setting for patients with […]

Case Presentation: A 46-year-old white male with a history of prior MI (at age 37) presented to ED with left-sided weakness, facial droop, and decreased left-arm sensation. He did not have a history of obesity, hypertension, smoking, excess alcohol consumption, or hyperlipidemia but had a family history of a sister who had a stroke in […]

Background: High rates of venous thromboembolism (VTE) have been reported with coronavirus disease 2019 (Covid-19). However, studies have predominantly focused on hospitalized patients. The risk of VTE in outpatients with Covid-19 is less known. Methods: We conducted an observational study of adults (age ≥18 years) enrolled in two large, integrated healthcare delivery systems serving >9 […]

Background: Symptomatic venous thromboembolism (VTE) occurs in about 1% of patients within 3 months after admission to a medicine ward.1,2 The 9th Edition American College of Chest Physicians Guidelines recommends the use of pharmacologic VTE prophylaxis in acutely ill hospitalized medical patients at increased risk of thrombosis and suggests against its use in low risk […]