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.

Acute pulmonary embolism

First tests: Clinical pretest probability, 12-lead ECG, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine.

Only if indicated: D-dimer, CT pulmonary angiography, Ventilation/perfusion imaging, Bedside echocardiography, Troponin and BNP/NT-proBNP, Venous compression ultrasound.

Repeat monitoring: Oxygenation, BP and perfusion.

Suspected deep vein thrombosis

First tests: Clinical DVT probability.

Only if indicated: D-dimer, Venous compression ultrasound, Repeat venous ultrasound.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine.

• Diagnosing Deep Venous Thrombosis (DVT)
• Diagnosing Pulmonary Embolism (PE)