PO47 - A Vascular Journey

Background: Most physicians follow a patient with a venous thromboembolism (VTE) disorder for a couple of years and manage the complications and interplay of the VTE and its treatment with other significant medical conditions the patient may develop.

In my years of residency, and then progressing to a consultant, I trace the journey of one of my patients with whom I learnt many aspects of thromboembolism as well as life lessons that would remain etched far longer than the medical knowledge.

Aims: We describe an elderly male who presented with the first episode of apparently unprovoked VTE. We discuss the work up for the first VTE episode, the rationale behind the work up and management plans.
Subsequent to the episode, we understand the recurrent episode, the rationale behind certain decision and treatment options in light of the evolving evidence, guidelines.

Methods: During the patient's lifespan reaching well into his nonagenarian age, we describe the various incidents related to the VTE and its treatment: bleeding and recurrent VTE while on anticoagulation, perioperative bridging for surgery, impact of liver impairment and chronic kidney disease, acute coronary syndrome and the interplay of antiplatelet and anticoagulants, heart failure, medication interaction and social and psychological factors that impact the patient's management plans.

Results: We explore an often-unchartered territory of discussing withdrawal of anticoagulation towards the end of life, alignment of goals of medical care with those of the patient and his caregivers, the implications of risk versus benefit, the monitoring issues and what matters most to patient's.

Conclusion(s): As a physician who develops a relationship with the patient and carers, traversing with them the journey of anticoagulation, I explore my own fears and apprehensions. Conversation and reflections lead to life's own lessons, overcoming shortfalls, admitting areas where science fails, and the art of medicine come into play.