Max is 40 years old and loves to snowboard regularly, with the ambition of becoming a snowboarding instructor. Max has been a habitual smoker since he was 25 years old. Just over 2 years ago, he experienced a deep vein thrombosis (DVT) and was prescribed rivaroxaban. He stopped anticoagulation treatment after 6 months. During this time, Max quit smoking; however, 6 months after he stopped treatment, he had another DVT event and was prescribed rivaroxaban again. After this event, Max was tested and diagnosed with a homozygous Factor V Leiden mutation. Now a decision needs to be made whether to continue his anticoagulation treatment, but Max is worried that anticoagulation will get in the way of his life.
How can Max get the best protection from venous thromboembolism (VTE) with a treatment regimen that fits his lifestyle?
Just a year after meeting her first grandchild, Claire received a lung cancer diagnosis. She was forced to give up her hobby as a frequent hiker and struggled to stay active due to the burdens of her treatment; Claire later developed a deep vein thrombosis (DVT). For the treatment of her DVT, Claire was prescribed rivaroxaban because she expressed a preference for an oral anticoagulant. Six months have passed, and Claire has not experienced a recurrent DVT nor any adverse events. A decision is now needed on whether she requires extended anticoagulation to reduce the risk of recurrent venous thromboembolism (VTE) or if treatment can be safely discontinued.
Monica is 82 years old, loves to travel and has been planning her dream holiday in the Caribbean with her new partner, Lionel. She leads a busy life, regularly volunteering at a suicide prevention helpline and frequently visiting family and friends.
She was diagnosed with type 2 diabetes last year after routine blood tests performed by her GP found a high serum glucose. While at her primary care centre for a diabetes review, she mentioned occasional palpitations to the practice nurse who performed a 12-lead ECG, diagnosing atrial fibrillation (AF).
Considering her age and comorbid diabetes, how would you approach Monica from the perspective of managing her AF?