Splenic Infarct, Atrial Fibrillation

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Warfarin vs Warfarin: Pros Tried and true (has been used for >50 years) at reducing risk of stroke Cheap (but hidden cost of INR monitoring) Reversible (vit K, FFP) Can use to kill rats Cons Slow onset Frequent INR monitoring Multiple drug interactions DTI’s and Apixiban direct thrombin inhibitors and apixiban Pros As effective or more effective at preventing clots Less bleeding complications No need for monitoring Faster onset than warfarin Cons Can’t reverse (with anything, even FFP); recent article in Circulation suggests rivaroxaban can be reversed with “prothrombin complex concentrate” Expensive (but no cost of INR monitoring) New (post marketing side effects sure to come) Utility in rat killing unproven
SUMMARY DIFFERENTIAL AND WORKUP FOR SPLENIC INFARCTION DON’T FORGET TO EVALUATE THE ATRIAL RHYTHM IN A PACED PATIENT INCLUDE SYSTEMIC EMBOLI IN YOUR DIFFERENTIAL FOR SOMEONE WITH A HISTORY OF A-FIB NEW ANTICOAGULANTS FOR CARDIOEMBOLIC PROPHYLAXIS IN A-FIB
Page 1 and 2: Morning report Resident: Bijan Ghas
Page 3 and 4: MKSAP A 43-year-old man is evaluate
Page 5 and 6: MKSAP Which of the following is the
Page 7 and 8: MKSAP Because a bicuspid valve is s
Page 9 and 10: HPI Pain History: Location: Diffus
Page 11 and 12: Physical Exam Vitals: T 38.3 HR 60
Page 13 and 14: CXR
Page 15 and 16: CT abdomen New splenic broad wedge
Page 17 and 18: Differential Diagnosis of Splenic I
Page 19 and 20: Modified Duke Criteria for the Diag
Page 21 and 22: TEE Read: - No evidence of vegetati
Page 23 and 24: This is what you see . . . . Though
Page 25 and 26: OUR PATIENTS A-FIB WAS A BIT HARDER
Page 27 and 28: OUR PATIENTS RECENT EKGS
Page 29 and 30: OUR PATIENTS RECENT EKGS
Page 31 and 32: Our patients recent EKgs
Page 33 and 34: Patient transitioned from heparin t
Page 35 and 36: Can it still go somewhere else? Leu
Page 37 and 38: Warfarin: Results in biologically i
Page 39 and 40: RE-LY: Dabigtran vs Warfarin for A-
Page 41 and 42: ROCKET: Rivaroxaban vs. Warfarin: R
Page 43 and 44: ARISTOTLE: Apixaban vs. Warfarin fo
Page 45: RE-COVER: Dabigatran vs. Warfarin f

Splenic Infarct, Atrial Fibrillation

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