HASH33M

[د. أحمد المري @djyab_]

نكسر المعروف واحرق الميم وشكك انه Ai😂
اسرع مرة تفهم فيها ECG من اورثو🔥

[Abdulhamid @abdulhamid_199]

لو اجتمعت الثلاث علامات هذه

ايش التشخيص المحتمل ؟؟

[إجازة @KSAEJ3]

🇸🇦💚

[Pete Santilli 🇺🇸 🇮🇹 🎙️ @petersantilli]

I can make you see colours that don’t exist.

Stare at the black cross.
Don’t look away.
Don’t blink if you can help it.

Countdown…
Then the color disappears.

You’re looking at black and white —
but your brain paints the pig pink and the frog green.

Did it work?

[د. أحمد المري @djyab_]

اسرع فحص وينفع تفتكره في الاوسكي بس لا تقوله😂

[Dr. Chokri Ben Lamine @abouabdrahman0]

🩸 Anticoagulation Cheat Sheet 💊 | High-Yield Review 🧵

1️⃣ Drug Classes
🔹 UFH / LMWH: Heparin, Enoxaparin, Dalteparin, Tinzaparin
🔹 Direct Thrombin Inhibitors (DTIs): Argatroban, Bivalirudin, Dabigatran
🔹 Direct Xa Inhibitors (DOACs): Rivaroxaban, Apixaban, Edoxaban, Betrixaban
🔹 Vitamin K Antagonist: Warfarin

2️⃣ Reversal Agents 🚑
🟢 Heparin / LMWH ➜ Protamine sulfate (LMWH only partially reversed)
🟢 Dabigatran (Pradaxa®) ➜ Idarucizumab (Praxbind®)
🟢 Apixaban (Eliquis®) / Rivaroxaban (Xarelto®) ➜ Andexanet alfa (Andexxa®/Ondexxya®) or 4-factor PCC if unavailable
🟢 Warfarin ➜ Vitamin K + 4-factor PCC (± FFP if PCC unavailable)

3️⃣ Monitoring 🧪
✅ UFH: aPTT or Anti-Xa
✅ LMWH: Anti-Xa (selected patients)
✅ Warfarin: PT/INR
❌ Routine coagulation monitoring is not required for DOACs.

4️⃣ Renal Pearls 🩺
🟠 Dabigatran = most renal clearance ⚠️
🟠 Rivaroxaban, Edoxaban, Betrixaban = dose adjustment/avoidance in CKD
🟢 Argatroban = preferred in severe renal dysfunction
🟢 Bivalirudin = reduce dose in renal impairment

5️⃣ Hepatic Pearls 🫀
⚠️ Most Xa inhibitors require caution or avoidance in significant hepatic impairment (especially Child-Pugh B/C depending on agent).
🟢 Heparin and LMWH generally require no hepatic dose adjustment.

6️⃣ Before Procedures ⏳
💉 UFH: hold 4–6 h
💉 LMWH: usually 12–24 h
💊 DOACs: generally 24–72 h depending on bleeding risk and renal function
💊 Warfarin: stop ~5 days before elective surgery; bridging only for selected high-thrombotic-risk patients.

7️⃣ HIT Pearls 🚨
🔴 Stop all heparin products
❌ Don’t switch to LMWH
✅ Start a non-heparin anticoagulant:
• Argatroban
• Bivalirudin
• Fondaparinux (selected patients)

8️⃣ Major Drug Interactions ⚠️
💊 DOACs ↔ CYP3A4/P-gp inhibitors & inducers
💊 Warfarin ↔ Numerous drugs + Vitamin K intake + antibiotics + liver disease
🌿 Herbal interactions:
Garlic 🧄 Ginkgo 🍂 Ginseng 🌿 Ginger 🫚 Feverfew 🌼 Willow bark 🌳

9️⃣ Exam Pearls 🎯
⭐ Protamine only partially reverses LMWH
⭐ Idarucizumab = Dabigatran antidote
⭐ Andexanet alfa = Xa inhibitor antidote
⭐ 4-factor PCC is the key alternative when specific antidotes are unavailable
⭐ Fondaparinux does not cause HIT and may be used in selected HIT patients.

📚 References
• 2025 Practical Guidance on DOACs. Internal Medicine Journal.
• ACC Expert Consensus on Anticoagulant-Related Bleeding (2020).
• ACC Perioperative Management of DOACs (2024).

#Hematology #Anticoagulation #DOAC #Warfarin #HIT #FOAMed #MedEd #PatientSafety

[HASH33M @hash333m]

@mcgillmedicines VTE

[HASH33M @hash333m]

@DrAyubaD Torsion

[HASH33M @hash333m]

@Madihealth2026 Permethrin

[HASH33M @hash333m]

@ibra_resh نرجع لسوالف كيبورد عربي وتعريب ووكلاء خليجيين ولعب بالاسعار

[HASH33M @hash333m]

@c0kciddiyim @bskrdoab @cagataaaaay Anti ro

[HASH33M @hash333m]

@abdulhamid_199 Sternocledomastoid

[Abdulhamid @abdulhamid_199]

نسبة الصعوبة : ⭐️⭐️⭐️⭐️⭐️

التشخيص هو ؟

[فلسفة مُلهمة ‏| QASEM BIN ALI @QQ7AT]

" الفرق بين القراءة و المشاهدة ."

[قورجس @gorgeous4ew]

صيدلي يحذر:

مسكن " catafast" المتداول لديه اعراض جانبية، تابع المقطع! https://t.co/RbrFG3JzyC

[مستشفى اليمامة @YAMAMHR2]

تأجيل الدورة الشهرية لأداء مناسك الحج

#مستشفى_اليمامة
#تحمع_الرياض_الصحي_الثاني

[AJOG @AJOG_thegray]

AJOG Expert Review in Preeclampsia: Pravastatin, proton-pump inhibitors, metformin, micronutrients, and biologics: new horizons for the prevention or treatment of preeclampsia https://t.co/bZC757FqKm

[HASH33M @hash333m]

@Shaweesh_ شوي من عندك يامعلم 👽🤝