MBBS OSCE · Haematology
OSCE — Anticoagulation Therapy
Eight-minute OSCE station on Anticoagulation Therapy: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Anticoagulation Therapy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Anticoagulants prevent and treat thromboembolic disease by interfering with the coagulation cascade at specific points: the parenteral heparins (antithrombin-potentiation), the vitamin K antagonist warfarin (impairs II, VII, IX, X, protein C/S synthesis; monitored by INR), the direct oral anticoagulants (DOACs) — dabigatran (direct IIa inhibitor), and rivaroxaban, apixaban, edoxaban (direct Xa inhibitors). Indications: atrial fibrillation (CHA2DS2-VASc), VTE (DVT/PE), mechanical heart valves, ACS. Warfarin requires INR monitoring (target 2–3 for most; 2.5–3.5 for mechanical mitral), has slow onset (3–5 days) needing LMWH bridging, and is reversed by vitamin K + PCC. DOACs need no routine mon
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Life-threatening bleed on warfarin (INR above 8 with bleeding, or any major blee |
| Safety | Life-threatening bleed on dabigatran: idarucizumab 5 g IV (two 2.5 g vials); on |
| Safety | Platelet count fall by 50 percent or platelets below 150 within 5-14 days of hep |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.