Maryam Shams, MD

resident at @sutterhealth | interested in #PCCM , Polaroid photography, and spending time by the ocean

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🩸 Bleeding on anticoagulation is NOT a complication… it’s a turning point

⚠️ The problem

We prescribe anticoagulants to prevent:

👉 Stroke
👉 MI
👉 VTE

But the most frequent complication is:

👉 Bleeding

And here’s the uncomfortable truth:

> Bleeding often determines prognosis more than thrombosis

🧠 Why this matters

Bleeding is NOT just an event.

It triggers:

❌ Treatment interruption
❌ Fear-driven underdosing
❌ Permanent discontinuation

👉 Leading to ↑ stroke, ↑ MI, ↑ mortality

🔥 Key clinical reality

📊 Major bleeding:

~1-3% per year

30-day mortality >15%

1-year mortality >25%

👉 That’s NOT benign

⚖️ The real battlefield

Every anticoagulated patient lives here:

👉 Thrombosis vs Bleeding

And we often focus on only one side.

🧠 What experts are telling us (ESC)

This is the new paradigm 👇

1️⃣ Risk is dynamic

Bleeding risk is highest:

👉 Early after starting anticoagulation
👉 In elderly / multimorbid patients

👉 Reassess continuously, not once

2️⃣ Not all bleeding is equal

🚨 Critical sites = high mortality:

Intracranial
GI
Retroperitoneal
Pericardial

👉 Even small volumes can kill

3️⃣ Combination therapy is dangerous

👉 OAC + antiplatelet = 2–3× ↑ bleeding

✔️ De-escalate EARLY
✔️ Avoid triple therapy when possible

4️⃣ Prevention is powerful

Simple interventions:

✔️ PPI for GI protection
✔️ Avoid NSAIDs / SSRIs when possible
✔️ Correct dosing (DOAC underdosing = worse outcomes)

👉 Most bleeding is preventable

🚨 When bleeding happens

Think in 3 steps:

🩸 1. Stabilize

Stop anticoagulant

Airway, oxygen, access

Fluids + transfusion

🧪 2. Reverse (if needed)

VKA → PCC + Vitamin K

Dabigatran → Idarucizumab

FXa inhibitors → PCC (± Andexanet)

🔎 3. Find and control the source

Endoscopy
IR embolization
Surgery

⚠️ The biggest mistake

> “Let’s stop anticoagulation and never restart”

🧠 The evidence says:

👉 NOT restarting = ↑ stroke + ↑ death

✔️ Restart early when safe
✔️ Individualize timing + dose

🔄 The future

We are moving toward:

👉 Personalized anticoagulation
👉 Dose tailoring
👉 Drug selection based on bleeding profile

🎯 Take-home message

Anticoagulation is NOT binary.

It is:

👉 A continuous balance
👉 A dynamic decision
👉 A personalized therapy

🤓 Final thought

> The goal is not to avoid bleeding
The goal is to survive both bleeding AND thrombosis

📚 Reference
Galli, M., Simeone, B., ten Berg, J., et al. (2026). European Heart Journal: Acute Cardiovascular Care.
https://t.co/dovWgN9BEu

[The PERT Consortium® @PERTConsortium]

Exciting news — Registration is now open for PERT Consortium's 12th Annual Pulmonary Embolism Scientific Symposium 2026 Annual Meeting

Thursday, October 1 – Saturday, October 3, 2026
Join us at the Marriott Copley Plaza in Boston, Massachusetts — we can't wait to see you there!

Register by May 1 to secure the Early Bird Special pricing. 🐦 https://t.co/UM2sMEOTZN

[Eduard Argudo @EduardArgudo]

Post-resuscitation care after #ECPR is a key frontier in extracorporeal life support. This new international consensus in @JAHA_AHA provides structured guidance for this complex phase of care. Glad to have contributed as a member of the expert panel #ECMO
https://t.co/1rdGBREyHQ

[AHA Science @AHAScience]

The 2026 Guideline on the Management of Dyslipidemia was recently published.

Here are the top 10 things for health care professionals to know.

[The PERT Consortium® @PERTConsortium]

Join the PERT Consortium Trainee Council!
If you're passionate about shaping the future of VTE care, collaborating with PERT leaders and driving meaningful change, apply today — Deadline is March 2nd!
https://t.co/znJ70ioE0C

[Maryam Shams, MD @docyams]

@NaviKaurMD @accpchest Had a fantastic first time at #CHEST2025 with my mentor and coresidents! Super grateful for the opportunity to present some interesting cases this year

[Hyeon-Ju (HJ) Ali, MD @HJRyooAli]

#CHEST2025

✅ Great sessions on PoPH

💡HPS can be cured by liver transplantation
💡With current era’s PH mgmt, non-severe PoPH (mPAP<45 mmHg) pts can be optimized for liver Tx
💡Dr. @OSitbon - perhaps a future for liver transplantation for mgmt of POPH..?

[The PERT Consortium® @PERTConsortium]

Proud moment! Incoming Board VP @FMaeWestMD speaking at #CHEST2025 on best practices for patient care #PERT

[Maryam Shams, MD @docyams]

Dr Namita Sood presented such an interesting clinical case of a patient with PE causing hemodynamic collapse needing VA ECMO. To wrap up the PERT session. The patients journey was a rollercoaster! It was such an engaging discussion, loved how involved the crowd was at #CHEST2025

[Maryam Shams, MD @docyams]

Enjoyed @DrNikkiMit ‘s talk on starting your own Diet #PERT at your community hospital, loved the Diet Coke can! #chest2025

[Maryam Shams, MD @docyams]

@DrHooksDO shared a fantastic infographic at #CHEST2025 PE is the third leading cause of mortality worldwide, his work with the Michigan CTEPH collaboration network is inspiring for #PERT programs!

[Maryam Shams, MD @docyams]

@DrHooksDO sharing a fantastic infographic slide at ##CHEST2025 PE is the third leading cause of mortality, his involvement in the Michigan CTEPH collaboration network is an inspiring addition for #PERT programs nationwide

[Maryam Shams, MD @docyams]

Dr Samant gave an insightful talk at #CHEST2025 on the foundations of forming a #PERT team @PERTConsortium

[Maryam Shams, MD @docyams]

Had a great time enjoying #PERTTrainee Council with such a wonderful group of trainees and mentors!

[Ibrahim Zahid, MD @ib_zahid]

PERT Trainee Council 2025-26 with our lovely mentors!
#myteamisbetterthanyours
#pertconsortium #perttraineecouncil #SanDiego #eleventhannualmeeting
@PERTConsortium

[Maryam Shams, MD @docyams]

Dr. Dinu Balanescu led a fantastic interactive case report session at the #PERTTrainee bootcamp at #PERT2025 @PERTConsortium

[Maryam Shams, MD @docyams]

Great to see Dr. Jane Ehret present a very interesting at the #PERTTrainee boot camp @PERTConsortium

[Maryam Shams, MD @docyams]

At #PERT2025 hearing the PI of the ATTRACT trial, Dr. Suresh Vedanthem, speak about our ongoing PE trials

[Maryam Shams, MD @docyams]

Grateful to be a #PERTTrainee at #PERT2025 this year in San Diego!

[TA✨ @DrPharmDMDTh]

Classification Of Asthma 🫁