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Choosing Wisely Canada

Canadian Hematology Society

Early pregnancy losses are common amongst healthy women. Current guidelines do not support the routine screening of women with pregnancy loss for inherited thrombophilias. Moreover, there are recommendations against instituting thromboprophylaxis in women with inherited thrombophilias wishing to achieve a successful term pregnancy. By performing testing for inherited thrombophilias, patients may be unnecessarily exposed to the harms of thromboprophylaxis, inappropriately labeled with a ...

Choosing Wisely Canada

Canadian Hematology Society

Patients on warfarin with a low-risk for thrombotic events do not require bridging anticoagulation. If interruption is necessary, warfarin can be stopped 5 days prior to a planned procedure and resumed when it is felt to be safe to do so afterwards. Bridging with LMWH or UFH has been shown to cause excess bleeding when compared with no bridging and may ultimately delay resumption of warfarin. High-risk patients (e.g. mechanical mitral valve, venous thromboembolism within the last 3 months or ...

Choosing Wisely Canada

Canadian Hematology Society

Treatment for ITP is recommended for a platelet count less than 30x10^9/L. Corticosteroids are considered first-line treatment, with the addition of intravenous IgG reserved for severe ITP and bleeding, when a rapid rise in platelets is required, or when corticosteroids are contraindicated. There is no evidence of benefit of intravenous IgG in combination with corticosteroids for first-line treatment of asymptomatic ITP. Unnecessary intravenous IgG infusions can result in multiple adverse ...

Choosing Wisely Canada

Canadian Headache Society

Lifestyle issues and specific trigger management can contribute considerably to successful migraine control. Patient education regarding these factors may reduce the need for expensive medications and reduce indirect costs related to disability. Training in relaxation and other stress management techniques should be considered. Training in other skills like pacing activities to help patients manage their schedules and stress levels well, and how to take acute medications appropriately are also ...

Choosing Wisely Canada

Canadian Headache Society

All acute medications used for migraine attacks, when used too frequently, increase the risk of medication overuse headache with progression to a chronic daily headache syndrome. Use of opioids, triptans, ergotamines, or combination analgesics of any kind on 10 days a month or more, and use of NSAIDs or acetaminophen on 15 days a month or more places patients at risk for medication overuse headache. Patients with migraine should be educated with regard to these risks.