Background: The direct oral anticoagulants (DOACs) apixaban and rivaroxaban are increasingly prescribed due to convenient oral formulation without the need for routine laboratory monitoring and are now commonly regarded as first line anticoagulants in most cases of venous thromboembolism (VTE). However, the optimal choice of subsequent anticoagulant in instances of first line DOAC failure is [...]

Case Presentation: A 70-year-old male presented to ED with a 10-day history of fever with chills, sweating, abdominal pain and generalized weakness. The abdominal pain was predominant in right lower quadrant (RLQ), accompanied by nausea, vomiting, loss of appetite and significant weight loss more than 10 lbs. in 10 days. He denies jaundice, pruritus, constipation, [...]

Case Presentation: This is a 77 year old woman with a history of severe aortic stenosis, severe mitral regurgitation, and chronic atrial fibrillation (afib) on coumadin. In 2017, she underwent bioprosthetic aortic valve replacement, mitral valve repair, biatrial ablation (Maze procedure), and left atrial appendage ligation (WATCHMAN procedure), after which she was to continue coumadin [...]

Case Presentation: A sixty-six-year-old male with a history of Monoclonal Gammopathy of Undetermined Significance (MGUS), Atrial Fibrillation, and Rheumatic Heart Disease requiring aortic and mitral valvuloplasty, was on warfarin with an INR goal of 3.5-4 due to multiple hypercoagulable factors and recurrent Transient Ischemic Attacks (TIAs) at INR 2.5-3.5. Post prostate cancer radiation, he developed [...]

Case Presentation: A 55-year-old patient with history of Crohn s disease complicated by small bowel obstruction s/p resection and ileocolonic anastomosis, and transition to Upadacitinib from infliximab, a month prior to the admission, presented with a three-day duration of worsening abdominal pain, non-bloody diarrhea, and intermittent fevers. Vital signs notable for temperature of 102.2F and [...]