The Clotting Patient

• Know the patterns: HIT, TTP, DIC, catastrophic APS, warfarin-induced skin necrosis, and heparin resistance.
• Catastrophic APS: triple therapy of anticoagulation + steroids + PLEX/IVIG.
• For warfarin necrosis, stop warfarin, give vitamin K, and maintain alternative anticoagulation without stopping the heparin too early.
• Skip thrombophilia testing in the acute phase, since illness and thrombosis skew the levels.
• DOACs are not recommended in triple-positive APS — warfarin remains the standard.

Diagnosing Deep Venous Thrombosis (DVT)

• DVT suspected → venous Doppler ultrasound
• Venous Doppler ultrasound result?
• Positive → treatment-dose anticoagulation
• Negative → continue prophylactic-dose anticoagulation
• Repeat examination after 3–5 days if symptoms otherwise unexplained

Diagnosing Pulmonary Embolism (PE)

• PE suspected → spiral CT (preferred) -or- ventilation/perfusion scan
• Test result?
• Test positive → initiate anticoagulation
• Test indeterminate → venous ultrasound (consider serial examination)
• Venous ultrasound result?
• Positive → initiate anticoagulation
• Negative → look for other cause of symptoms
• Test negative → look for other cause of symptoms