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CanadiEM Podcasts: CRACKCast, ClerkCast, First Year Diaries

CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. The CanadiEM Podcast brings you cutting edge clinical topics on the National Rounds Series and delves into the struggles that doctors face on the Physicians as Humans Series.

Sep 16, 2019

The same 65-year-old man who was seen earlier with an ICH has now recovered. His past medical history is remarkable for hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His list of medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. Should his anti-coagulation be resumed? If so, how long should the clinician wait prior to re-starting his medications?

Objective 1: Summarize the most recent guidelines regarding when to re-start anti-coagulation after ICH (ASA, DVT-P, Xa inhibitors, warfarin)
Objective 2: What factors need to be taken into consideration when making this decision?
Objective 3: Interpret the evidence behind the guidelines
Objective 4: Describe instances where one would consider re-starting anti-coagulation earlier/later
Objective 5: Develop an approach to re-starting anti-coagulation after ICH including which agent to use and why
Objective 6: How would you approach this scenario?
Objective 7: What do guidelines suggest?
Objective 8: Would scenario change depending on type of valve? What if the indication was AF, not mechanical valve?
Objective 9: Does the type of bleeding matter? (lobar versus deep ICH)