The Curbsiders Internal Medicine Podcast #499 Inpatient DOAC Dilemmas with Dr. Jori May
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Sep 22, 2025 Dr. Jori May, an expert in thrombosis and coagulation at the University of Alabama-Birmingham, dives into the complexities of DOAC treatment in hospitalized patients. He discusses what constitutes anticoagulation failure and the key factors to consider, such as missed doses and patient adherence. Insights on when to switch to warfarin, the implications of D-dimer levels, and the evaluation of anatomical causes of thrombosis are highlighted. Dr. May emphasizes the importance of thorough assessment before changing anticoagulation therapies, ensuring effective patient care.
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Prefer Apixaban In Renal Dysfunction
- Favor apixaban in renal dysfunction because it is less renally cleared.
- In ESRD on dialysis consider dose reduction and reassess bleeding risk frequently.
Search For Anatomical Drivers
- Investigate anatomical causes (May‑Thurner, thoracic outlet, post‑thrombotic scarring) for recurrent clots.
- Order proximal imaging if standard ultrasound misses iliac or central lesions.
Phone Your Radiologist For Chronicity Clues
- Call radiology and discuss features distinguishing acute versus chronic thrombus; don't trust the report alone.
- Use ultrasound features (vein dilation, soft clot vs scar) to infer chronicity.