Case Presentation: Spontaneous spinal epidural hematoma (SSEH) is a hematoma that happens without an insult. Although a rare entity, it can result in spinal cord compression. Etiologies include anticoagulant therapies, coagulopathies, blood dyscrasias, pregnancy, and vascular malformations (1). We present a case of SSEH in the setting of heparin and clopidogrel use during a vascular [...]

Background: Prophylactic anticoagulation is effective at reducing the risk of venous thromboembolism (VTE), but can also increase the risk of bleeding. Whether anticoagulant prophylaxis should be modified for underweight patients to minimize bleeding complications is unknown.  We sought to determine whether being underweight is associated with the risk of major bleeding in hospitalized medical patients [...]

Background: Heparin-induced thrombocytopenia (HIT) syndrome is an immune-mediated disorder producing thrombocytopenia and thrombosis, with or without prior exposure to heparin. Although avoidance of heparin products and non-heparin anticoagulants are used, immune-based therapies including intravenous immunoglobulin have been tried when the thrombocytopenia persists or there is breakthrough thrombosis. We sought to systematically review and analyze the [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is an antibody-mediated pro-thrombotic disorder which occurs after exposure to heparin product. Diagnosis of HIT type II is rather challenging as affected individual often has other causes of thrombocytopenia and a delayed discontinuation of heparin in HIT type II is associated with a mortality rate of 20-30%. 4Ts score is a [...]

Background: Hospitalized patients receiving direct oral anticoagulants (DOACs) sometimes require bridging with unfractionated heparin (UFH). Monitoring UFH with anti-Xa assays has been shown to correlate with better outcomes. However, DOACs interfere with anti-Xa assays resulting in inappropriate UFH dose adjustments that can negatively impact patient care. In 2015, we deployed an electronic health record (EHR) [...]

Background: Venous thromboembolism (VTE) is a preventable and potentially fatal condition for which hospitalized medical patients are at risk. Compared with the more traditional option of unfractionated heparin, low molecular weight heparin (LMWH) has been shown to be superior for VTE prophylaxis with regard to both efficacy and bleeding risk, and to have a lower [...]

Background: Thrombocytopenia is common in hospitalized patients. Heparin Induced thrombocytopenia (HIT) is a life threatening condition which can lead to extensive thrombosis. Diagnosis of HIT relies on clinical suspicion determined by 4T score, and the immunoassays through testing for anti PF4/Heparin antibodies. Clinical practice guidelines published by the American Society of Hematology (2013) recommended to [...]

Background: Heparin-Induced Thrombocytopenia (HIT) is a rare (0.1-1% of heparinized medical patients) but devastating (up to 10% mortality) side-effect of heparin administration[1].  In thrombocytopenic patients, the pre-test probability of HIT is estimated by the validated “4Ts Score”, which is used to risk-stratify patients into Low (0-3 points), Intermediate (4-5 points), and High (6-8 points) likelihoods [...]

Case Presentation: A 30-year-old-woman presented to the hospital for unilateral headaches of one-week duration. Her headache was described as progressive onset, dull, radiating to the neck, and was associated with nausea and vomiting. Past medical history was notable for recent laparoscopic removal of ovarian cyst and sinusitis. Her only medication was a combined estrogen progesterone [...]

Case Presentation: A 68-year-old man presented with dyspnea, wheezing and productive cough. He was hypoxemic and a chest radiograph revealed a left lower lobe infiltrate and he was admitted with a Chronic Obstructive Pulmonary Disease exacerbation and pneumonia. His troponin was mildly elevated and he was started on a heparin infusion. The intravenous line infusing [...]