Background: Warfarin-associated adverse drug events are dangerous, common, and costly. Anticoagulation safety is a national priority. While multiple tools exist for warfarin management in the outpatient setting, there is a dearth of guidance with regard to inpatient management. This study aims to: 1) describe a health system’s inpatient chronic warfarin quality metrics, defined by International [...]

Background: Widespread use of new oral anticoagulants (NOAG) for Atrial Fibrillation (A-Fib) has increased the annual incidence of gastrointestinal bleed (GIB) in recent years. These NOAG agents in our study include Rivaroxaban, Apixaban and Dabigatran. Convenience of use, quick onset, broad therapeutic window and eliminating need for frequent monitoring makes NOAGs attractive for A-Fib associated [...]

Background: Bridging anticoagulation is commonly prescribed to patients with atrial fibrillation who are initiating therapy or require interruption of anticoagulation for procedures. Current guidelines recommend bridging for patients at high risk of stroke, but no data guide this recommendation. Among patients with atrial fibrillation and one or more risk factors for thromboembolic stroke, the recently [...]

Background: Strategies to reverse the effect of warfarin, a vitamin K antagonist (VKA), may be necessary for patients who are actively bleeding, asymptomatic with markedly elevated INR values, or requiring urgent invasive procedures. The purpose of this quality improvement activity (QIA) was to evaluate adherence to the 2012 CHEST guidelines for use of vitamin K [...]

Case Presentation: A 61 year old female presented to the emergency department with 1 day of nausea, vomiting, and fever. The day prior to her symptom onset, she had undergone a colonoscopy for colon cancer screening that was normal. Her medical history was notable for splenectomy in 2000 for a hamartoma.On presentation, her temperature was [...]

Case Presentation: A 60-year-old, Guatemalan female without prior medical history presented with a transient, erythematous, burning, rash involving her extremities and torso (Figure 1). Additional symptoms included fatigue, chills, joint pain, early satiety and weight loss. Blood counts, metabolic panel and serum protein electrophoresis were normal. C-reactive protein (13 mg/L, normal (N)

Case Presentation: A 88-year-old female presented to an outpatient office with 3 weeks history of severe progressive bruising and ecchymosis which initially developed on left wrist and then spread to bilateral upper extremities, upper trunk and bilateral breast. Patient was recently diagnosed with intraductal adenocarcinoma of right breast (T2,N2,M0, Stage IIB). She declined surgery and tamoxifen (20 [...]

Background: While the Coronavirus Disease 2019 (COVID-19) pandemic has substantially affected health outcomes globally, care strategies have varied in different regions. For example, while US hospitals primarily admitted patients with severe COVID-19, hospitals in Egypt admitted most symptomatic COVID-19-positive individuals per the May 2020 Ministry of Health and Population management protocol. Additionally, the use of [...]

Case Presentation: A 19 year-old Caucasian woman presented with progressive fatigue, dyspnea on exertion and dizziness for 3 weeks. Her symptoms were preceded by an unknown bug bite approximately 3 weeks ago. She was seen in urgent care two weeks prior to admission and given a course of unknown antibiotics and started on steroids. She [...]

Case Presentation: A 50 year-old African American female with medical history of morbid obesity (BMI 40.8), hypertension, hyperlipidemia, diabetes mellitus, obstructive sleep apnea, atrial fibrillation, right MCA infarct one year prior to admission, and right renal infarct one month prior to admission presented with two days of sharp left-sided abdominal pain associated with non-bloody and [...]