anticoagulation
Clinical teaching and practical ideas for your next study session.
Acute Cholangitis on Warfarin: Separate Drainage From Sphincterotomy
With obstructed cholangitis and an INR of 3.2, the key procedural question is whether urgent duct decompression can be separated from sphincterotomy and stone extraction. Stent-only ERCP may be appropriate when the patient’s condition, anticoagulation, and technical feasibility favor staging—but the INR and procedure plan both need context.
Apixaban Before Type A Aortic Dissection Repair: Protect the Bypass Plan
A recent apixaban dose complicates emergency Type A dissection repair. Learn how to assess residual drug, weigh reversal, and avoid compromising heparinization for cardiopulmonary bypass.
INR 11.2 Without Bleeding: Safe Warfarin Reversal Without Overcorrection
An INR above 10 is a management threshold, not a cue for indiscriminate reversal. Learn how to confirm truly absent bleeding, consider low-dose oral vitamin K, monitor the response, and restart anticoagulation safely.
Sepsis-Associated Atrial Fibrillation: Is the Rhythm Causing Shock?
A fast irregular rhythm in sepsis may be the culprit, a consequence, or both. This case-based discussion teaches how to determine whether AF is driving instability, choose rate control versus synchronized cardioversion, and plan follow-up after recovery.