Welcome to the Emergency Medicine Cases podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine

from EMC studios in Toronto.

In part one on DOAC's use and misuse, we talked about how DOACs work, their efficacy and safety

compared to warfarin, how to dose them,

and when to avoid them. We also covered isolated calf DVT, superficial vein thrombosis,

and anticoagulation in a fib. In this part two, doaxin bleeding, we're going to go through

a few cases showing the range of risk of badness in patients bleeding on DOACs.

We see this all the time.

So from minor risk like epistaxis, where local control is easy to access, to moderate risk like a stable GI bleeder, to major risk,

bleeding into a closed fixed space like ICH.

In each of these cases, we'll discuss how to weigh the risks and benefits of stopping the DOAC,

when reversal the DOAC is advised, and how best to accomplish the reversal.

We'll have an EBM bottom line on the evidence for the newest reversal agent, and we'll discuss when we should and should not stop DOACs for different procedures.

Now, before we jump into the first case, apologies for those of you who couldn't get a spot for the sold-out 2017 EM cases course.

We'll be thinking about maybe expanding the course a bit for the following year.

Another great case-based course that I'll be speaking at is Whistler's update in EM at the end

of February with EM case's guest experts, Chris Hicks, Joel Yaffe, Eric Latofsky, Anil Chopra,

Aaron Ciel, the brains behind the amazing casted course, who, by the way, we're going to have on the show soon.

Sarah Gray, Jason Fisher, and Dave McKinnon.

All right, let's get into Doaxon bleeding.

Here's case number one.

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