Dual Anticoagulation in Recurrent Thromboembolic Events with Failure of Monotherapy: A Novel Approach.

In the last few decades many new anticoagulants (i.e direct thrombin and factor ten inhibitors) have been introduced with efficacy that rivals older drugs in the treatment of venous thromboembolism (VTE). However, for all their success, management of patients with recurrent thromboembolic events is still a challenging clinical scenario and not well addressed in the literature. We report the case of a young female with recurrent thromboembolisms in spite of using both newer agents and more conventional therapies. Ultimately, she is started on dual anticoagulation with warfarin and rivaroxaban without recurrence. This case report demonstrates that dual anticoagulants can be utilized in patients with recurrent VTE who fail single agent therapy. It also underscores the need for studies further elaborating on the utility of dual anticoagulants as a treatment modality for patients failing monotherapy.

Major hereditary gastrointestinal cancer syndromes: a narrative review.

Gastrointestinal cancer is one of the major causes of death worldwide. Hereditary gastrointestinal cancer syndromes constitute about 5-10% of all cancers. About 20-25% of undiagnosed cases have a possible hereditary component, which is not yet established. In the last few decades, the advance in genomics has led to the discovery of multiple cancer predisposition genes in gastrointestinal cancer. Physicians should be aware of these syndromes to identify high-risk patients and offer genetic testing to prevent cancer death. In this review, we describe clinical manifestations, genetic testing and its challenges, diagnosis and management of the major hereditary gastrointestinal cancer syndromes.