The risk of hemorrhage is significant, and the benefit is unclear. A one-treatment-for-all approach cannot be applied.
The Clinical Picture
The patient had received pelvic radiation 10 years earlier for prostate cancer.
In massive pulmonary embolism, thrombolytic therapy is usually indicated; in submassive cases the decision is not so clear.
IM Board Review
Despite revascularization, the next day the patient had an ejection fraction of 35% and a mass in the left ventricle.
Symptoms of ischemia may be difficult to recognize in younger patients, thus delaying diagnosis.
ADAMTS13 testing is useful in diagnosing this disease, guiding therapy, and predicting relapse.
The benefit is much less clear for stable disease than for acute coronary syndromes.
Anticoagulation should not be interrupted for dental surgery.
From the Editor
All risk calculators—not just for anticoagulation—are based on the “average” patient. And no patient is average.
We have tools, but their predictive value is modest. Clinical judgment is important.