I think the bottom line for this ADS is “Adam, you need to review your primary literature for anticoagulation”. The session certainly brought up a lot of primary literature, but also raised a couple of clinical controversies. The take-home messages I got were:
– Basically anyone who is immobile, has recently had surgery, or has cancer or another medical condition predisposing to clots requires DVT prophylaxis. Harking back to Clinical Orientation, the words of Mike: “You need to talk yourself out of DVT prophylaxis rather than into DVT prophylaxis”.
– Hip surgery > knee surgery for clot risk, therefore treat longer.
– The BRIDGE trial only included A-fib patients with a mean CHADS2 of 2, so only consider bridging therapy for high-risk clotters…in terms of other high-risk clotting scenarios, there is less to no evidence.
– CONTROVERSY: the rivaroxaban EINSTEIN-PE trial, although it showed non-inferiority to warfarin, had a wide confidence interval (CI), whereas AMPLIFY had a tighter CI when showing non-inferiority to warfarin.
– I always thought VTE treatment in cancer patients was always with indefinite duration until malignancy is resolved, but it turns out it is >6 months. PO options for this population are pending trials (MATISSE subgroup)