Background: Thrombotic disorders, such as venous thromboembolism (VTE) and ischemic stroke are highly prevalent conditions. In many cases, an underlying inciting risk factor is clearly visible that can explain the thrombotic event. When a clear explanation is not found, diagnoses such as “idiopathic VTE” and “cryptogenic stroke” are made. Except when there is a concern [...]

Background: Thrombophilia testing is frequently ordered in the inpatient setting. However, testing is costly and can be misleading in the setting of acute thromboembolism or concurrent anticoagulation use. Furthermore, hereditary thrombophilias do not predict a clinically significant increase in VTE recurrence. Methods: We conducted an educational intervention with a randomized cross-over design for Internal Medicine [...]

Background: Updated guidelines recommend testing for inherited or acquired thrombophilias only in rare situations in the acute inpatient care setting, as it has little impact on acute management of thromboembolic events, and in some situations, can be falsely positive leading to inappropriate care. Current data in our academic medical center indicate testing for thrombophilia occurs [...]

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 [...]

Case Presentation: A 46-year-old white male with a history of prior MI (at age 37) presented to ED with left-sided weakness, facial droop, and decreased left-arm sensation. He did not have a history of obesity, hypertension, smoking, excess alcohol consumption, or hyperlipidemia but had a family history of a sister who had a stroke in [...]

Background: The American Society of Hematology (ASH) advises against routine thrombophilia testing in hospitalized patients with new venous thromboembolism (VTE) due to the potential for inaccurate results during the acute phase of the disease. Thrombophilia testing is generally reserved for outpatient follow-up, once the acute event has resolved. However, testing may be appropriate in specific [...]

Case Presentation: We present a 25-year-old female with history of antithrombin III deficiency, recurrent PEs and DVTs due to medication noncompliance, currently on therapeutic anticoagulation with Lovenox who presented to the ED with a headache. Patient was recently discharged from an outside hospital 4 days prior after being admitted for chest pain, headache and lightheadedness. [...]