Background: Factor concentrates such as 4 factor-prothrombin complex concentrate (4F-PCC) are commonly used off-label as reversal agents in factor Xa inhibitor-associated bleeding events. However, there have been limited studies on the efficacy and safety of 4F-PCC use in these settings. We conducted a retrospective observational study of the use of 4F-PCC for major bleeding occurring [...]

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), affects one to two per one thousand persons annually in the US. Treatment of VTE consists of anticoagulation therapy, and evidence supports treating patients with low-risk VTEs as outpatients.  Novel oral agents such as rivaroxaban, an oral factor Xa inhibitor, require less [...]

Case Presentation: A 46-year-old female presented with a 2-day history of shortness of breath, pleuritic chest pain and lower extremity swelling while taking low-molecular weight heparin (LMWH). One month prior she was diagnosed with a left lower extremity DVT after a hysterectomy. She was treated with LMWH with a planned transition to rivaroxaban. Medical history [...]

Case Presentation: An 87-year-old man with medical history significant for hypertension, non-ischemic cardiomyopathy, paroxysmal atrial fibrillation (anticoagulated on Rivaroxaban) and ventricular tachycardia (recently started on Amiodarone) presented to the emergency room with chest pain. He reported that the pain started insidiously 2 days prior to presentation, pleuritic, sharp, retrosternal and intermittent, associated with diaphoresis and [...]

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 [...]