Anticoagulation and Antiplatelet Therapy — DCE Clinical Case

Focused history — what you must establish

• The clot: symptom onset, exertional tolerance, haemoptysis, syncope — and any prior VTE or family history that reframes "unprovoked" ^[4].
• The provoking-factor hunt: recent surgery, immobilisation, long-haul travel, oestrogen therapy — their absence is what makes this unprovoked and triggers the malignancy lens ^[4].
• The cancer screen: weight loss, change in bowel habit, rectal bleeding, haemoptysis, night sweats, new lumps, dysphagia, urinary symptoms; screening participation (bowel, prostate); smoking and alcohol history.
• Bleeding-risk inventory: prior GI bleeding, NSAID use, antiplatelets, liver disease, renal function — these will shape agent choice once the caecal mass is confirmed, because an unresected GI luminal tumour changes the bleeding calculus ^{[1] [2]}.
• The treatment horizon: planned colonoscopy (biopsy bleeding), likely surgery, and probable chemotherapy with its interactions and thrombocytopenia — the anticoagulant must survive his cancer journey.
• The patient's frame: what he has been told, what he fears, and his capacity for twice-daily tablets versus injections.