Background: Guidelines recommend pharmacologic venous thromboembolism (VTE) prophylaxis for high risk hospitalized medical patients that do not have an elevated bleeding risk.  A systematic review of randomized trials estimates the overall bleeding risk with pharmacologic prophylaxis to be low, at 1/1000 (0.1%).  However, it is unclear if the bleeding events were related to pharmacologic prophylaxis [...]

Background: Over the last two decades concerns have been raised about the potential risk of blood transfusion over the benefits. General restrictive red blood cell (RBC) transfusion approach for anemic hospitalized patients (thresh hold of 7 gm %) has been adopted by American hematology society (AHS) in 2012. It is important to recognize that guidelines [...]

Background: Oral anticoagulation is effective for reduction of risk for stroke and systemic embolism in patients with nonvalvular atrial fibrillation, but there may be uncertainty about how to manage anticoagulation in and following an emergency procedure or after treatment of hemorrhage. In case of an emergency, anticoagulation would ideally be immediately and completely reversed, bringing [...]

Background: Worldwide, 200 million adults undergo non-cardiac surgery annually, and completing pre-operative assessments is a major role of today’s hospitalists. In previous years, decisions regarding anti-platelet agents were less evidence-based and often fell to provider preference. With the release of POISE-2 in 2014, there is now stronger evidence to support holding aspirin before elective surgery [...]

Background: UGIB is a common cause of inpatient admissions often associated with morbidity and an overall mortality rate approaching 10%. Since therapy is different, it is important to differentiate between variceal and non-variceal GI bleeding. While both will often need volume resuscitation, proton pump inhibitors (PPI), judicious transfusion and early endoscopy, patients with variceal bleeding [...]

Case Presentation: 59 year old female presented to the emergency department complaining of two weeks of atraumatic, painful bruising to her lower extremities, right shoulder, and lower back. She was unable to bear weight on her right lower extremity due to pain.  She denied any history of anticoagulant or antiplatelet usage, and denied any family [...]

Case Presentation: An 80-year-old man with a past medical history of chronic lymphocytic leukemia, coronary artery disease, diabetic chronic kidney disease and heart failure reduced ejection fractionwith two months of intermittent hematochezia. Since onset of symptoms, the patient had required nine transfusions. His admission exam was remarkable for jugular venous distension, trace ankle edema, a [...]