Podcasts about anticoagulation

Are you up to date with the latest guidelines on deep venous thrombosis (DVT) management? Dr. Steven Abramowitz, vascular surgeon at MedStar Health, joins host Dr. Chris Beck for a deep dive into emerging clinical data in DVT management, where they review the evolving indications for mechanical thrombectomy and the implications of studies like the ATTRACT trial, the CLOUT registry, and the ongoing DEFIANCE trial. --- This podcast is supported by: Inari Medicalhttps://www.inarimedical.com/artix-system --- SYNPOSIS Dr. Abramowitz reviews recent data comparing outcomes of mechanical intervention versus lytic-based therapy, outlining how each approach fits into current practice. He underscores the critical role of IVUS in determining treatment endpoints, while noting the ongoing challenge of an absent standardized definition. The conversation also offers practical insights on procedural techniques and the evolving role of anticoagulation, emphasizing the importance of close collaboration and open communication with referring physicians. --- TIMESTAMPS 00:00 - Introduction00:45 - Overview of DVT Management02:50 - New Guidelines for DVT Treatment07:30 - Technical Endpoints in DVT Treatment13:26 - Clout Registry and Its Findings17:57 - Anticoagulation and DVT23:05 - Defining Acute DVT Management27:00 - Evolving Approaches to Acute DVT28:19 - Patient Experience and Quality of Life31:08 - Referring Providers and Data Impact37:01 - Single Session Treatments and Stenting41:07 - Chronic Venous Disease Management --- RESOURCES (ATTRACT) Weinberg I, Vedantham S, Salter A, et al. Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial. Vasc Med. 2019;24(5):442-451. doi:10.1177/1358863X19862043https://pubmed.ncbi.nlm.nih.gov/31354089/ (CLOUT) Shaikh A, Zybulewski A, Paulisin J, et al. Six-Month Outcomes of Mechanical Thrombectomy for Treating Deep Vein Thrombosis: Analysis from the 500-Patient CLOUT Registry. Cardiovasc Intervent Radiol. 2023;46(11):1571-1580. doi:10.1007/s00270-023-03509-8https://pubmed.ncbi.nlm.nih.gov/37580422/ (DEFIANCE) Abramowitz SD, Marko X, D'Souza D, et al. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025;281:92-102. doi:10.1016/j.ahj.2024.10.016https://pubmed.ncbi.nlm.nih.gov/39491572/

Join us as we review recent articles and news featured in The DIGEST #70, including PSA screening, acetaminophen and autism, COVID19 vaccines and cancer, and aspirin and anticoagulation in coronary artery disease. Fill your brain hole with a delicious stack of hotcakes! Featuring Drs. Paul Williams (@PaulNWilliamz), Nora Taranto (@norataranto), Rahul Ganatra (@rbganatra), Laura Glick (@lauraglick) and Matt Watto (@doctorwatto). Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! |Mailing List | Contact | CME! Credits Written and Hosted by: Nora Taranto MD; Rahul Ganatra MD MPH, Laura Glick MD, Paul Williams, MD, FACP, Adam Cifu MD, Matthew Watto MD, FACP Cover Art: Rahul Ganatra, MD MPH Reviewers: Rahul Ganatra MD MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP; Sai S Achi MD, MBA, FACP Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Prostate Cancer Screening Acetaminophen and Autism COVID19 vaccines and cancer risk Aspirin and anticoagulation in coronary artery disease Outro Sponsor: Aura Frames For a limited time, save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carver Mat frames by using promo code CURB at checkout. Sponsor: DoxGPT by Doximity Visit doxgpt.com  and see how it can simplify your clinical workflow, from patient care to paperwork.  Sponsor: Continuing Education Company Use promo code Curb30 to get 30% off all online courses and webcasts—just for Curbsiders Listeners. Visit CMEmeeting.org/curbsiders to learn more. Sponsor: Freed Use code: CURB50 to get $50 off your first month when you subscribe!

Welcome back to the tasty morsels of critical care podcast. This is the second of 2 parts on PE in critical care. The first focused on risk stratification and this one will focus on management. There is a link to a transcript of a more comprehensive talk with references on emergencymedicineireland.com for those keen enough to dive a little deeper. As noted in the last podcast this one leans very heavily on “in the my experience” level of the evidence pyramid and should be weighted as such. For this discussion I’m going to assume your patient is in the ESC High risk category, ie hypotensive with a PE on imaging and you’re satisfied that the PE is causing the hypotension. I do believe there is a tiny cohort of the PE population who warrant aggressive reperfusion even with a normal appearing BP but at this stage I cannot say I have any evidence or guidance to really identify who they are and back that up. For the original talk I gave on this to an EM audience, I split the interventions into helpful , distractions, and not helpful. It was probably a little bit of a provocative division if I’m honest. The slide is on the site for reference and viewing it will likely make what follows more edifying. For the resus room patient in the first 30-60 mins I feel comfortable to standby my assertion that a short list of “helpful interventions” should includes lysis, anticoagulation, noradrenaline, oxygen and some CPR. In the ICU however we’re often present both at the first 30-60 mins but over next hours and many of the items on the “distraction” list become a little more relevant with time. Number 1 on my list of helpful interventions is thrombolysis. As mentioned, if you have found PE and you have satisfied yourself that the sickness and hypotension you’re seeing is caused by that PE then you need to have a good reason not give thrombolysis. The evidence base is not high level RCTs but it is a class 1 recommendation on the ESC guidelines and the list of class 1 interventions is really quite short. In the 25 year old in resus with a massive PE day 3 after an arthroscopy the decision here seems pretty straightforward. However in the post trauma patient in the ICU with massive PE with a small traumatic SAH and an improving SDH and a recent laparotomy then the decision is orders of magnitude more complex and you may well find a very good reason why lysis is not an option. There is not a straightforward answer to lysis because it will vary from patient to patient but I would emphasis that it is a question worth dedicating a decent chunk of your cognitive bandwidth to. Dosing in an unstable patient is often 10mg of alteplase followed by 90mg over 2 hrs. Dosing in a cardiac arrest situation is typically a 50mg bolus. Anticoagulation is one of the other class 1 recommendations on the ESC list. Opinions vary on agent of choice. With my ICU hat on I will almost always advocate for UFH as I feel confident that if i stop it, the heparin effect will be gone in a couple of hours when the inevitable bleeding starts. Opinions vary and I know smart people who advocate for LMWH in this scenario with one of the arguments being you probably get more reliable and quicker anti Xa effect. Both the guidelines and your esteemed narrator recommend against volume resuscitation. Dumping a litre of crystalloid into the venous circulation will shift the IVS further towards the left impairing cardiac filling and doing the opposite of what you intended. A much better resuscitation fluid would be noradrenaline. This is remarkably effective in improving BP and perfusion and I have often used it when I am 90% sure the patient has a PE but haven’t quite got the CT scan to prove it. The noradrenaline can also buy you a little time to make a better decision about the lysis and reperfusion, converting what would have been an immediate decision into something that you maybe have more like 30 mins to make. Certainly if the noradrenaline dosage is rising and the right heart is struggling then adrenaline would be my add on inotrope of choice. Of course we know in the ICU we have a plethora of other agents available to us with lots of theoretical advantage on pulmonary vascular resistance etc. They would rarely be my first line, certainly not in the ED population but I would often reach for them a little further down the line once i have a better handle on the physiology and what they might tolerate. Enough to say that staring someone on 0.5mcg/kg/min milrinone as a single agent with a starting BP of 60/40 is not likely to end well in this context Oxygenation is strongly endorsed given its proclivity for reduction in PVR, however intubating someone in this context to facilitate oxygenation is likely to result in a catastrophic haemodynamic collapse. The adage “resuscitate before you intubate” or even “reperfuse before you intubate” has some relevance here. I find CPR to be helpful in the context of massive PE, not simply for the usual reasons of preserving some degree of forward flow but I suspect there is a mechanical effect of breaking up or moving clot more distally. I have frequently seen stuttering intermittent ROSC in this context. I would suggest caution with the mechanical CPR devices as the presence of a liver lac in the context of tPA is unlikely to be well tolerated. While not available or that relevant to the emergency medicine population I do think the addition of nitric in the ventilated ICU patient who develops nasty PE seems like a low risk intervention with potentially massive gains. There is a small RCT of nitric in the spontaneous breathing PE population that did not however show benefit. I put mechanical devices in the “distraction” category in my original talk as I don’t think they have much relevance in the early stage of resuscitation. However if you have kept them alive long enough or if you have a true contraindication to lysis or a failed lysis then they may well have a role. I have found the evidence base so far here decidedly underwhelming and for catheter directed lysis in particular i struggle to see how a mg/hr tpa via a pulmonary catheter is any different than a mg/hr of tpa via a peripheral IV line given that the entire venous return ends up in the pulmonary circulation either way. The thrombectomy devices are certainly more compelling from a physiological perspective and the obvious and dramatic changes in physiology on removal of clot are quite compelling. But they are a tremendous faff requiring a catheter akin to an ECMO catheter to be threaded into the pulmonary circulation. The recent PEERLESS trial gave an average 90 min procedure time emphasizing the need to keep the patient alive long enough to receive the intervention. I do feel this has a role in our management quiver I am just unsure what that role is, but more evidence in the coming years will likely clarify VA ECMO is undoubtedly a fantastic physiological support for a dying PE patient but bear in mind it is almost definitely not available to you in the vast majority of hospitals in the Ireland and the UK. PERT teams are groups of relevant physicians willing to weigh in on difficult PE cases to advise on management. I put PERT teams in the distraction category. And I feel bad about that because they're usually filled with knowledgeable and enthusiastic people . But there are 2 errors I've seen on this that we should be aware of. One is on us as primary clinicians where we outsource the decision to lyse in someone who has a clear indication. This is not necessarily the fault of the PERT team but there is risk to the patient in delaying as it is a tremendous faff trying to get hold of the relevant people and then get them to agree. The second distraction that can happen is the recommendation for interventions in a patient that they have not seen and are not present to. A couple of times I have had to talk people out of IR interventions that frankly were not needed because the patient was getting better with conventional treatment. Do not underestimate the importance of being at the bedside and seeing the patient and evaluating response to treatment. Surgery, in terms of pulmonary embolectomy is the third and final class 1 recommendation in the ESC guidelines for high risk PE. All be it with a very low evidence rating. It gets talked about in papers and guidelines but you're talking about taking someone who is already mostly dead into theatre, lined, anaesthetised, chest opened and onto bypass. There probably is a role for it somewhere and in certain institutions and it's often raised in the context of contraindications to lysis but those same contraindications to lysis usually apply to the 30000 units of heparin you need to get them on bypass. It seems to suffer from the old goldilocks flaw of “not sick enough” for theatre or “too sick” for theatre I have clearly done way beyond my usual brevity in this scenario but honestly didn’t think anyone could tolerate a 3rd part on PE. Full refunds are available on request For further reading it is probably best to visit the original lecture post where the relevant papers are all listed with a little smattering of critical appraisal thrown in for good measure.

Program notes:0:50 Fish oil supplements and hemodialysis1:50 1200 individuals to fish oil or not2:50 Needs another study3:11 PCSK9 inhibitor in people without MI or stroke4:13 3- or 4-point MACE5:11 Getting LDL down helps6:11 Addition of more than one oral agent6:50 Right therapy for afib and a stent7:50 Noninferiority trial8:50 After 12 months single agent works9:27 Anticoagulation after afib tx10:30 Low primary safety outcomes11:25 96% won't have a stroke12:16 End

Send us a textIn this CHNC 2025 episode, The Incubator speaks with Dr. Sandy John (Seattle Children's) and Dr. Kelsey Montgomery (Riley Children's Hospital) about the collaborative work of the CDH Focus Group within the consortium. They discuss a national effort to evaluate bivalirudin versus heparin for ECMO anticoagulation in infants with congenital diaphragmatic hernia—a shift driven by promising anecdotal evidence but lacking robust data. Through shared cases, systematic review, and consensus guideline development, the group aims to unify practice and elevate research quality. The conversation highlights how real-time collaboration accelerates learning, improves care consistency, and fosters innovation across Level IV NICUs nationwide.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

New study suggests taking thyroid medication WITH food may be just as good as taking it on an empty stomach; Natural support for Parkinson's Disease; Reviving the lost art of handwriting may be key to kid's learning; Dr. Jeffrey Bland does a deep dive on why not all fish oils are alike.

Send us a textWelcome back Rounds Table Listeners! Today we have a solo episode with Dr. Mike Fralick. This week, he discusses a recently published trial looking at aspirin in patients with chronic coronary syndrome receiving oral anticoagulation. Here we go!Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation (0:00 – 9:43).Throwback to EPIC-CAD: The Rounds Table Episode 94: Top Papers from the 2024 European Society of Cardiology Congress The Good Stuff:Trial Files is a free monthly newsletter on practice-changing trials, delivered straight to your inbox (https://trialfiles.substack.com/).Guidelines summaries coming to Trial Files soon!Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePods

Listen in to round out our conversation about anticoagulation, by hearing from two Anticoagulation Stewardship Pharmacists - Hadley Bortz from the Alfred in Melbourne and Julianne Chong from Concord Hospital. Find out more about ACS programs in Australia and overseas and the benefits that these programs can bring to your health service. Anticoagulant patient care plan Anticoagulation Forum Advancing Anticoagulation Stewardship: A Playbook CATAG Medicines Stewardship Toolkit 

Program notes:0:53 Who needs a beta blocker after MI1:53 Those with mild reduction of ejection fraction2:53 Confined to those with 40-50% ejection fraction3:15 Revascularization in NSTEMI4:20 Composite outcome5:20 Closes gap, do FFR6:20 May not be physiologically significant6:40 Is lifelong anticoagulation needed after ablation7:41 Occurred less in those who stopped8:30 RSV, cardiac events and hospitalizations9:30 Lower hospitalization in those who got the vaccine10:30 Acute respiratory illness hospitalization11:30 Less benefit with existing CVD or immunocompromise12:15 Several RSV vaccines13:16 End

From new techniques to evolving best practices–are you up to date with the latest developments in carotid artery stenting? In this episode, Dr. Wayne Olan, Interventional Neuroradiologist and the director of Minimally Invasive Neurosurgery at George Washington University joins Dr. Michael Barraza for a discussion on the latest innovations and evolving techniques in carotid artery stenting.---This podcast is supported by:RADPAD® Radiation Protectionhttps://www.radpad.com/---SYNPOSISDr. Olan opens the conversation with a historical perspective on the evolution of carotid stenting, tracing advancements from early techniques to modern devices. He then talks through referral patterns, noting that the majority originate from cardiologists. Dr. Olan emphasizes the importance of meticulous periprocedural planning and comprehensive post-procedural management. Central to this discussion is the critical role of antiplatelet therapy, including strategies for addressing Plavix non-responders, such as the use of Integrilin. The discussions also covers advanced techniques in carotid artery stenting, including the utilization of the Aptus sheath and the Contego stent system. He underscores the importance of mastering the available tools, understanding patient-specific factors, meticulous procedural planning, and always maintaining a contingency plan. He concludes the discussion by exploring emerging trends and the future potential of outpatient carotid stenting.---TIMESTAMPS00:00 - Introduction02:44 - The Importance of Stroke Intervention07:16 - Carotid Stenting: Evolution and Techniques13:29 - Challenges and Collaborations in Carotid Interventions16:17 - Technical Insights and Best Practices25:24 - Choosing the Right Wire for Carotid Procedures25:53 - Anticoagulation and Filter Wire Techniques28:30 - Managing Stent Placement and Distal Protection30:54 - Handling Carotid Bifurcation and Skull Base Lesions38:43 Dealing with Tandem Occlusions42:06 - Future Trends in Outpatient Procedures44:43 - Addressing Re-stenosis and Vertebral Lesions45:44 - Conclusion and Final Thoughts

Dr. Dan Ackerman talks with Dr. Urs Fischer about the optimal timing of anticoagulation after ischemic stroke in patients with atrial fibrillation.  show reference: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00439-8/fulltext  

Dr. Dan Ackerman talks with Dr. Urs Fischer about the optimal timing of anticoagulation after ischemic stroke in patients with atrial fibrillation.  Read the related article in The Lancet.  Disclosures can be found at Neurology.org.   

Join us as we talk with Prof Prash Sanders about the role of anticoagulation for patients with atrial fibrillation (AF), learn when patients should be screened for AF, how to perform a stroke risk assessment and strategies to reduce the risk of bleeding.  This podcast is in collaboration with Medcast and the Quality Use of Medicines Alliance, a provider of health professional education in Australia focused on the quality use of medicines. Check out their resources here. Clinical guide: Anticoagulant management for AF Anticoagulant patient care plan Prof Prash Sanders is a cardiologist and electrophysiologist with a focus on heart rhythm disorders, particularly atrial fibrillation. He graduated with Honours from the University of Adelaide and completed advanced training in Melbourne and Bordeaux, France, earning national and international recognition for his research and clinical expertise. He is the Clinical Director of Cardiac Electrophysiology at the Royal Adelaide Hospital and holds the Knapman – National Heart Foundation Chair of Cardiology Research at the University of Adelaide. Dr Sanders has published over 600 papers and is a leader in advanced ablation techniques. He consults and performs procedures across multiple hospitals and regional clinics in South Australia. Jarrah is a clinical pharmacist with a passion for education and quality use of data. He has led national health programs, including GP audit and feedback initiatives and Indigenous health nKPIs. He is currently clinical lead at MedCast, supporting best practice care through the Quality Use of Medicines Alliance.  

This episode covers: Cardiology This Week: A concise summary of recent studies Oral anticoagulation in atrial fibrillation: answers to frequent questions Smartwatch, heart rate and ECG Milestones: Lyon Diet Heart study Host: Emer Joyce Guests: Carlos Aguiar, Tim Chico, Paulus Kirchhof Want to watch that episode? Go to: https://esc365.escardio.org/event/1811 Want to watch that extended interview on smartwatch, heart rate and ECG? Go to: https://esc365.escardio.org/event/1811?resource=interview   Disclaimer ESC TV Today is supported by Bristol Myers Squibb and Novartis. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsors.  This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. The ESC is not liable for any translated content of this video. The English-language always prevails.   Declarations of interests Stephan Achenbach, Emer Joyce and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Tim Chico has declared to have potential conflicts of interest to report: research funding from Google. Paulus Kirchhof has declared to have potential conflicts of interest to report: partially supported by European Union MAESTRIA (grant agreement 965286), British Heart Foundation (AA/18/2/34218), German Center for Cardiovascular Research supported by the German Ministry of Education and Research (DZHK, grant numbers DZHK FKZ 81X2800182, 81Z0710116, and 81Z0710110), German Research Foundation (Ki 509167694), Dutch Heart Foundation (DHF), the Accelerating Clinical Trials funding stream in Canada, and the Else-Kröner-Fresenius Foundation. Research support for basic, translational, and clinical research projects from German Research Foundation (DFG), European Union, British Heart Foundation, Leducq Foundation, Else-Kröner-Fresenius Foundation, Dutch Heart Foundation (DHF), the Accelerating Clinical Trials funding stream in Canada, Medical Research Council (UK), and German Center for Cardiovascular Research, from several drug and device companies active in atrial fibrillation, and has received honoraria from several such companies in the past, but not in the last five years. Listed as inventor on two issued patents held by University of Hamburg (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial Fibrillation WO 2016012783). Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada.  Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

Host: Emer Joyce Guest: Tim Chico Want to watch that extended interview on smartwatch, heart rate and ECG? Go to: https://esc365.escardio.org/event/1811?resource=interview Want to watch that episode? Go to: https://esc365.escardio.org/event/1811   Disclaimer  ESC TV Today is supported by Bristol Myers Squibb and Novartis. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsors.  This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. The ESC is not liable for any translated content of this video. The English-language always prevails.   Declarations of interests Stephan Achenbach, Emer Joyce and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Tim Chico has declared to have potential conflicts of interest to report: research funding from Google. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada.  Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

Anticoagulation with AF and Cancer   Guest: Nicholas Tan, M.D., M.S. Host: Anthony H. Kashou, M.D.   In today's episode of ECG Making Waves, Dr. Anthony Kashou interviews Dr. Nicholas Tan on how to manage anticoagulation in patients with cancer. They discuss the importance of appreciating the challenging balance in managing stroke risk in patients with cancer and atrial fibrillation. After listening to this episode, listeners will understand alternative strategies for stroke prevention in addition to systemic anticoagulation.   Topics Discussed: What is the relationship between cancer and atrial fibrillation? Why is stroke prevention challenging in this situation? What is the role of left atrial appendage closure in cancer patients? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Dr. Dan Ackerman and Dr. James Ernest Siegler discuss the complexities of treating ESUS and emphasize the importance of personalized treatment approaches based on individual patient factors.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213876 

Dr. Dan Ackerman talks with Dr. James Ernest Siegler about the complexities of treating ESUS and emphasizes the importance of personalized treatment approaches based on individual patient factors.  Read the related article in Neurology®. Disclosures can be found at Neurology.org. 

Master the latest approaches for treating venous thromboembolism with expert tips on direct oral anticoagulant (DOAC) selection, dosing, and duration. Learn how to tailor anticoagulation for special populations, handle treatment failures, and navigate long-distance travel risks. We're joined by Dr. Tara Lech, PharmD, CACP (Beth Israel Lahey Health, @AnticoagPharmD, @anticoagpharmd.bsky.social‬). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case 1 from Kashlak Choosing the right anticoagulant Distal deep vein thrombosis management Anticoagulation in special populations Case 2 from Kashlak Understanding treatment failure Anticoagulation reversal agents Outro Credits Producer, Writer, Show Notes, Infographic, Cover Art: Ben Furman  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Tara Lech, PharmD  Disclosures Dr. Lech reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Sponsor: Grammarly  Let Grammarly take the busywork off your plate so you can focus on high-impact work. Download Grammarly for free at Grammarly.com/PODCAST. Sponsor: Freed CURB50 to get $50 off your first month when you subscribe at freed.ai Sponsor: JournalFeed Try JournalFeed free for 7 days—and get 20% off your first year with code CURB25 at journalfeed.org/curb. 

Oral antiarrhythmics have limited efficacy and significant risks Catheter ablation is now a first-line option in suitable patients Newer ablation technology - Pulsed field ablation (PFA) is safer and faster Anticoagulation decisions remain based on stroke risk, not ablation status Genuine post-procedural issues may be benign Ongoing healthcare professional role - Blood pressure and risk factor control The questions answered in this podcast are listed below.They were compiled by GPs and health professionals around Australia who attended Healthed’s face-to-face seminars. How effective are oral antiarrhythmic medications? Does this cure atrial fibrillation? What is the current state of ablation technology? Can you explain what you mean by "rapid" and provide an example of how long a procedure typically takes? Does reduced scarring decrease the likelihood or complexity of needing a repeat ablation? What are some of the contraindications in terms of structurally abnormal heart that would be contraindications for the patient? How should atrial fibrillation be approached in patients with severe ischaemic heart disease? Does this complicate treatment? If a patient has an AF ablation, can they come off my anticoagulant? How do you manage patient’s embolic issues? How soon after the procedure can patients typically be discharged? Following successful AF suppression, is it possible for patients to stop taking DOACs or other anticoagulants? After discharge, how soon should patients follow up with their GP? What should the GP monitor and what should be communicated back to the specialist? When will you consider AV node ablation and insertion of a pacemaker? Host: David Lim | Total Time: 44 mins Expert: Prof Rukshen Weerasooriya, Sub-specialist Cardiac Electrophysiologist Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Send us a Text Message (please include your email so we can respond!)Episode 66! Today we talk about Acute Chest Syndrome in Sickle Cell Disease with one of our favorite hematologists, Benjamin Tillman! We base our discussion around the TASC trial or "Comparison of Prophylactic and Therapeutic Doses of Anticoagulation for Acute Chest Syndrome in Sickle Cell Disease" published by Dessap et al in AJRCCM April of 2025.Pubmed: https://pubmed.ncbi.nlm.nih.gov/40209087/AJRCCM: https://www.atsjournals.org/doi/10.1164/rccm.202409-1727OCIf you enjoy the show be sure to like and subscribe, leave that 5 star review! Be sure to follow us on the social @icucast for the associated figures, comments, and other content not available in the audio format! Email us at icuedandtoddcast@gmail.com with any questions or suggestions! Thank you Mike Gannon for the intro and exit music!

In this episode of Medicine Grand Rounders, we're join by hematologist extrodinaire Dr. Dana Angelini, who goes over the do's and don'ts of anticoagulation for the Internal Medicine Physician. Moderated by: Seysha Mehta, MS3

The controversial KETO-CTA study, tough decisions in subclinical AF, and another potentially huge benefit for GLP-1 agonist drugs are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I The KETO-CTA Study JACC Advances Paper: https://www.jacc.org/doi/10.1016/j.jacadv.2025.101686 Meta-analysis https://doi.org/10.1016/j.ajcnut.2024.01.009 II Subclinical AF – Anticoagulate or Not? Anticoagulation in Subclinical AF May Offer Little Benefit https://www.medscape.com/viewarticle/anticoagulation-subclinical-af-may-offer-little-benefit-2025a1000b31 Treat AFib ‘Diagnosed' by Smartwatch https://www.medscape.com/viewarticle/treat-afib-diagnosed-smartwatch-2025a1000avp JAMA NO paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2833437 NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 ARTESIA https://www.nejm.org/doi/full/10.1056/NEJMoa2310234 McIntyre meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.067512 Singer et al https://pmc.ncbi.nlm.nih.gov/articles/PMC2777526/ Stroke paper https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.123.045843 American Journal of Medicine paper https://pubmed.ncbi.nlm.nih.gov/38331136/ III GLP1a for Treatment of Fatty Liver Disease ESSENCE trial https://www.nejm.org/doi/10.1056/NEJMoa2413258 Features CABG Still Superior to Stents Despite FAME 3 Endpoint Swap https://www.medscape.com/viewarticle/cabg-still-superior-stents-despite-fame-3-endpoint-swap-2025a1000ao5 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This week, we discuss another set of high yield topic for anyone who cares for patients on anticoagulation - how to safely hold anticoagulation prior to a procedure and how to reverse the effects of the drug in the even of an emergent situation. We discuss our approach to how we discuss this with our patients and our medical colleagues! Dan also shares his dotphrases for your reference! Episode contents:- How do we approach peri-operative anticoagulation management? When do we hold? How long do we hold? Do they need bridging? No bridging? - In the case of a severe bleed, how do we reverse the effects of anticoagulation?**** Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Dr. Ziv Harel discusses findings from his study, "Anticoagulation for Patients with Atrial Fibrillation Receiving Dialysis: A Pilot Randomized Controlled Trial," with JASN Deputy Editor Manjula Kurella Tamura.

Interview with Steven J. Warach, MD, PhD, author of Optimal Delay Time to Initiate Anticoagulation After Ischemic Stroke in Atrial Fibrillation: A Pragmatic, Response-Adaptive Randomized Clinical Trial. Hosted by Cynthia E. Armand, MD. Related Content: Optimal Delay Time to Initiate Anticoagulation After Ischemic Stroke in Atrial Fibrillation

Interview with Steven J. Warach, MD, PhD, author of Optimal Delay Time to Initiate Anticoagulation After Ischemic Stroke in Atrial Fibrillation: A Pragmatic, Response-Adaptive Randomized Clinical Trial. Hosted by Cynthia E. Armand, MD. Related Content: Optimal Delay Time to Initiate Anticoagulation After Ischemic Stroke in Atrial Fibrillation

For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more!Half Dose DOAC for Long Term VTE Prevention (RENOVE)Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis)GPT-4 Assistance for Physician PerformanceOptimal Vasopressin Initiation for Septic Shock (OVISS)DOACs for A fib after ICH (PRESTIGE-AF)High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

Blood clots can be life-threatening, but understanding their causes and treatments can save lives. In Part 2 of our Hematology Series, Dr. Andrew Jenzer, DDS, dives deep into thrombosis, breaking down the three key contributing factors and the most common hypercoagulable conditions. We carefully dissect the pathophysiology of pulmonary embolisms, the most important guidelines to know and follow, the difference between provoked and unprovoked hypercoagulable conditions, and everything you need to know about the perioperative management of antithrombotic therapies. To close, Dr. Jenzer highlights the critical risk factors of preoperative anticoagulation and key takeaways from our conversation that should never be forgotten. If you're a healthcare professional or simply someone who values life-saving knowledge, this episode is packed with insights you won't want to miss. Tune in to sharpen your expertise and improve patient outcomes!Key Points From This Episode:Three contributors to thrombosis and the most common hypercoagulable conditions.Unpacking the pathophysiology of pulmonary embolisms.Wells' Criteria, CHEST, and other crucial guidelines to follow. The difference between provoked and unprovoked hypercoagulable conditions.  Anticoagulation therapies and important surgical considerations.Risk factors associated with the perioperative management of antithrombotic therapy. Recapping the key takeaways from today's conversation. Links Mentioned in Today's Episode:Dr. Andrew Jenzer Email — andrew.jenzer@gmail.com Dr. Andrew Jenzer | Duke Surgery — https://surgery.duke.edu/profile/andrew-clark-jenzer  ACOMS | Annual Winter Meeting — https://www.acoms.org/Events/Winter-Meeting/About Wells' Criteria for Pulmonary Embolism — https://www.mdcalc.com/calc/115/wells-criteria-pulmonary-embolism Wells' Criteria for DVT — https://www.mdcalc.com/calc/362/wells-criteria-dvt  American College of Chest Physicians — https://www.chestnet.org/  ‘Perioperative Management of Antithrombotic Therapy' — https://www.chestnet.org/guidelines-and-topic-collections/guidelines/pulmonary-vascular/perioperative-management-of-antithrombotic-therapy  ‘Perioperative Management of Patients with Atrial Fibrillation Receiving a Direct Oral Anticoagulant' — https://pubmed.ncbi.nlm.nih.gov/31380891/  ‘Perioperative Optimization and Management of the Oral and Maxillofacial Surgical Patient' — https://pubmed.ncbi.nlm.nih.gov/38103577/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

In this episode, Dr. Valentin Fuster summarizes the March 25, 2025, issue of the JACC, which focuses on advancements in electrophysiology. Highlights include groundbreaking studies on leadless pacemakers, atrial fibrillation treatments, and appropriate use criteria for cardiac devices, with key papers exploring the safety of pacemaker retrieval, the role of electrograms in ablation procedures, and long-term outcomes for left atrial appendage occlusion devices.

In this episode, we review the new 2025 ACC/AHA Acute Coronary Syndrome (ACS) guidelines, with a particular focus on guideline recommendations for analgesics, P2Y12 inhibitors, parenteral anticoagulation, and lipid management. Key Concepts Nitrates and opioids are recommended for symptomatic relief of chest pain. Some patients may not be appropriate for nitrates (e.g. recent PDE-5 inhibitor use, hypotension, or right ventricular infarction). Opioids are used for nitrate-refractory angina but have a theoretical risk of delaying the effect of oral antiplatelet medications. Prasugrel and ticagrelor are preferred P2Y12 inhibitors over clopidogrel in most patients. Patient-specific factors, including the use of PCI, play a role in P2Y12 inhibitor selection. Anticoagulation with heparin is recommended in nearly all acute coronary syndrome (ACS) scenarios. Alternative anticoagulants may be used depending on whether PCI/CABG is planned and whether the anticoagulant is used prior to PCI/CABG (“upstream”) or during the PCI procedure itself. LDL goals after ACS have changed again. All ACS patients should have an LDL goal < 70 with a consideration of an LDL goal of 55-69. A variety of non-statin therapies may be added to a high intensity statin regimen if LDL is not at goal. References Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online February 27, 2025. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309

In this episode, Stephen Cantrill, MD, FACEP; Rajesh T. Gandhi, MD; and Payal K. Patel, MD, MPH, FIDSA, discuss: Workup of COVID-19 in the emergency departmentMethods of COVID-19 risk stratification Treatment recommendations for people with severe COVID-19, including how to effectively use antiviral therapy, dexamethasone, and other immunomodulators[CC1] in this population A detailed patient case to illustrate key takeawaysPresenters:Stephen Cantrill, MD, FACEP​Associate Director and Medical Director (Retired) ​ Department of Emergency Medicine​ Denver Health Medical Center​ Associate Professor ​ Department of Emergency Medicine​ University of Colorado Health Sciences Center​ Denver, Colorado Rajesh T. Gandhi, MD​Massachusetts General Hospital​ Professor of Medicine​ Harvard Medical School​ Boston, Massachusetts Payal K. Patel, MD, MPH, FIDSA​Systemwide Director of Antimicrobial Stewardship​ Associate Professor, Division of Infectious Diseases​ Intermountain Health​ Salt Lake City, Utah Link to full program: https://bit.ly/4gu2gcUGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In this episode, Stephen Cantrill, MD, FACEP; Rajesh T. Gandhi, MD; and Payal K. Patel, MD, MPH, FIDSA, discuss treatment strategies for people who have severe COVID-19, including: Antiviral therapy with remdesivir Dexamethasone and other systemic corticosteroids Immunomodulators, such as JAK inhibitors or IL-6 inhibitors Overviews of clinical trial data demonstrating how and when to use these therapiesPresenters:Stephen Cantrill, MD, FACEP​Associate Director and Medical Director (Retired) ​ Department of Emergency Medicine​ Denver Health Medical Center​ Associate Professor ​ Department of Emergency Medicine​ University of Colorado Health Sciences Center​ Denver, Colorado Rajesh T. Gandhi, MD​Massachusetts General Hospital​ Professor of Medicine​ Harvard Medical School​ Boston, Massachusetts Payal K. Patel, MD, MPH, FIDSA​Systemwide Director of Antimicrobial Stewardship​ Associate Professor, Division of Infectious Diseases​ Intermountain Health​ Salt Lake City, Utah Link to full program: https://bit.ly/4gu2gcUGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.    

The POPular PAUSE TAVI trial investigated whether continuing or interrupting oral anticoagulation during transcatheter aortic valve implantation (TAVI) affected clinical outcomes. The randomized, open-label, noninferiority study included 858 patients and assessed a composite primary outcome of cardiovascular death, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days. The trial found that continuation was not noninferior to interruption, with higher bleeding risk but no significant difference in thromboembolic events, supporting interruption of anticoagulation in high-bleeding-risk TAVI patients.

We're back, after a brief hiatus! Today we talk about duration of therapy for bacteremia, Factor XI inhibition for atrial fibrillation, whether to stop ACEi or ARB before elective surgery, and whether GLP-1 agonists are beneficial in heart failure with preserved ejection fraction. Go to minute 7:30 to skip the banter. 7 vs 14 Days of Antibiotics for Bacteremia (BALANCE)Abelacimab vs Rivaroxaban for Atrial Fibrillation (AZALEA-TIMI-71)Asenduxian vs Apixaban for Atrial Fibrillation (OCEANIC-AF)ACEi or ARB Discontinuation Before Surgery (STOP or NOT)Tirzepatide for HFpEF and Obesity (SUMMIT)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

OPTION - Randomized Comparison of Left Atrial Appendage Closure with Oral Anticoagulation after Catheter Ablation for Atrial Fibrillation (OPTION)

Anticoagulation in Rural EM - Part One by SAEM

Anticoagulation in Rural EM - Part Two by SAEM

Anticoagulation in Rural EM - Part One by SAEM

Anticoagulation in Rural EM - Part Two by SAEM

Anticoagulation in Rural EM by SAEM

Micaela Warfield, PharmD shares updates on the timing of anticoagulation following stroke secondary to atrial fibrillation.   For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes.  You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on X @MayoMedE 

Dr. Jodie Roberts and Dr. Amra Sakusic discusses the relationship between reversal therapy and ischemic stroke, between duration off anticoagulation and risk of ischemic strokes or systemic embolism. Learn more about the Neurology Practice Current section and fill out the survey now. Show reference: https://survey.alchemer.com/s3/7969148/Practice-Current-When-do-you-start-anticoagulation-therapy-for-patients-with-both-ICH-and-AF https://www.neurology.org/doi/10.1212/WNL.0000000000209664