Podcasts about anticoagulation

Interview with Jacob E. Kurlander, MD, MS, author of Multilevel Stewardship Intervention for Use of Anticoagulation-Antiplatelet Therapy, and C. Seth Landefeld, MD, author of Deprescribing Inappropriate Medicines Across a Health System—Can We Improve the Care of Both Patients and Physicians? Hosted by Ilana Richman, MD. Related Content: Multilevel Stewardship Intervention for Use of Anticoagulation-Antiplatelet Therapy Deprescribing Inappropriate Medicines Across a Health System—Can We Improve the Care of Both Patients and Physicians?

On Episode 65 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the June 2026 issue of Stroke: "AI-Derived LA Volume Index, LA/RA and LA/LV Volume Ratios From Coronary Artery Calcium Scans Predict Long-Term Atrial Fibrillation and Stroke" and "Prevalence and Association of Atherosclerosis to Ischemic Stroke in Patients With Atrial Fibrillation on Anticoagulation." She also interviews Dr. Randolph Marshall, principal investigator of the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260603.690307

In this episode of The Cardiac Recovery Room, moderator Dr. Rawn Salenger, Chief of Cardiac Surgery at the University of Maryland St. Joseph Medical Center, engages in a conversation with Dr. Shuba Chatterjee, Associate Professor of Surgery and Director of Thoracic Surgical ICU and ECMO Program at Baylor College of Medicine in Houston, TX, USA, and nurse practitioner Amanda Rea, Lead of Advanced Practice and Clinical Program Manager in the Division of Cardiac Surgery at the University of Maryland St. Joseph Medical Center in Townson, MD, USA. Their conversation focused on hemodynamics and atrial fibrillation. Chapters  00:00 Intro  01:17 Vasoplegia/Vasodilatory Shock  06:13 Vasopressors, Cost Considerations  07:32 Vasoplegia Misconceptions  08:41 Defining Vasoplegia  10:54 Blood Pressure Target Variable  12:54 Inotropes  17:03 Approach to Atrial Fibrillation  19:08 Patient Monitoring  19:27 Surgical/Concomitant Ablation  23:13 Postop AFib, Preventive Strategies  28:37 Example Scenario, High Heart Rate  29:56 Out of AFib Into Sinus Rhythm  33:01 Anticoagulation  39:43 Key Points  Key topics include vasoplegia, vasodilatory shock, and the use of vassopressors, including norepinephrine. They address common misconceptions surrounding vasoplegia shock, the role of epinephrine, and the use of methylene blue. Their conversation further delves into approaches for atrial fibrillation, concomitant surgical ablation, and postoperative atrial fibrillation. They highlight the best preventative strategies for atrial fibrillation and the use of beta blockers for atrial fibrillation. Finally, they discuss current guidelines and the role of anticoagulation in patients with atrial fibrillation. The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode will be released featuring a leadership panel from the ERAS Cardiac Society.   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

Send us Fan MailHormone therapy is used across a wide range of clinical settings—from contraception and menopause management to pregnancy care and gender-affirming therapy. But how do these treatments influence thrombosis risk, and how should clinicians approach these decisions in practice?In this episode of CLOT Conversations, hosts Dr. Jameel Abdulrehman and Dr. Maha Othman speak with Dr. Leslie Skeith and Dr. Shannon Bates about their recent New England Journal of Medicine review on sex hormone influences on venous thrombotic and cardiovascular risk.The discussion explores the thrombotic effects of estrogen, progestogens, and testosterone; differences between hormone formulations; management considerations for patients with prior thrombosis; gender-affirming hormone therapy; and practical approaches to perioperative care.Whether you care for patients receiving contraception, hormone replacement therapy, or gender-affirming care, this episode provides evidence-based guidance to support informed clinical decision-making.For the full publication: https://www.nejm.org/doi/abs/10.1056/NEJMra2202438Support the showhttps://thrombosiscanada.caRegister today for our upcoming conference on November 7, 2026 in Montreal at https://thrombosiscanada.ca/2026ConferenceTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

When hemodialysis-dependent patients exhaust all conventional venous access options, how do IRs navigate complex central occlusions to provide a lifeline? In this episode of the BackTable Podcast, Dr. Gian Paolo Zamboni of Clínica Alemana in Santiago, Chile joins guest host Dr. Neil Jain to discuss workup protocols and advanced technical algorithms for complex central venous recanalization cases. --- Get the BackTable apphttps://www.backtable.com/app --- This podcast is supported by RADPAD® Radiation Protectionhttps://www.radpad.com/ --- Timestamps 00:00 - Introduction03:06 - IR Practice and Referrals in Santiago07:19 - Pre-Procedure Workup15:06 - Standard Recanalization Techniques20:14 - Dual-Access Sharp Recanalization24:43 - Needle Maneuvers and Alternatives29:32 - Predilation, IVUS, and Stent Sizing37:42 - Transhepatic Technique and Indications45:45 - Tract Closure, Anticoagulation, and Follow-up50:03 - Advice and Closing Remarks --- More about this episode The physicians review the critical role of pre-procedural planning, emphasizing the necessity of thorough workup with CT venography to accurately assess remaining vascular capital. Dr. Zamboni shares how his group addresses severe central venous occlusions, outlining a structured, stepwise approach that begins with standard maneuvers and progresses to sharp recanalization techniques before opting for dual-access approaches. He outlines critical safety measures, highlighting the importance of performing intraprocedural cardiac ultrasound, pre-dilating with caution, and keeping covered stents on the shelf to prevent fatal cardiac tamponade. For patients who lack viable conventional iliofemoral and IVC access, Dr. Zamboni shares an advanced jugular-to-transhepatic strategy, walking through the steps and nuances of creating a reliable working route, optimizing inflow, and managing post-procedure anticoagulation. Finally, Dr. Zamboni offers invaluable advice for IRs on mastering foundational techniques before tackling advanced cases and building strong, collaborative relationships with referring providers. --- BackTable Vascular & Interventional (VI) is the go-to podcast for interventional radiologists, vascular surgeons, and interventional cardiologists. Download the free BackTable app to get early access to new episodes, cases, and courses curated by physicians in your specialty. ► https://www.backtable.com/app

Send us Fan MailPost-thrombotic syndrome (PTS) affects up to half of patients following deep vein thrombosis and can significantly impair quality of life. Yet treatment options have historically been limited.In this episode of CLOT Conversations, David Airdrie and Dr. Jameel Abdulrehman speak with Dr. Susan Kahn about the recently published C-TRACT trial in The New England Journal of Medicine.The trial evaluated whether endovascular therapy, including iliac vein stenting, could improve outcomes for patients with moderate-to-severe post-thrombotic syndrome and iliac vein obstruction.Dr. Kahn discusses the rationale behind the study, key findings related to symptom burden and quality of life, the increased bleeding risk observed with intervention, practical patient selection considerations, and the unanswered questions that remain regarding long-term management after venous stenting.This episode provides clinicians with practical insights into one of the most important recent studies in the management of post-thrombotic syndrome.Reference:Vedantham S, Kahn SR, Marston WA, Weinberg I, Sista AK, Magnuson EA, Cohen DJ, Wasan SM, Razavi MK, Goldhaber SZ, Sanfilippo KM. Endovascular Therapy for Post-Thrombotic Syndrome—A Randomized Trial. New England Journal of Medicine. 2026 Apr 13.https://www.nejm.org/doi/abs/10.1056/NEJMoa2519001Support the showhttps://thrombosiscanada.caRegister today for our upcoming conference on November 7, 2026 in Montreal at https://thrombosiscanada.ca/2026ConferenceTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Cheryl Bushnell, MD, MHS, who served as the guest editor of the June 2026 Cerebrovascular Disease issue. They provide a preview of the issue, which publishes on June 3, 2026. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Bushnell is a Professor of Neurology and Director of the Center for Transformative Stroke Care at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @CBushnellMD  Full episode transcript available here Dr Jones: One of the core tenets of our field is that we learn neurology one stroke at a time. But what do we have to learn about preventing them altogether? The science of stroke prevention, acute treatment, and recovery are evolving rapidly, and it's hard to keep up. Today, we're speaking with Dr. Cheryl Bushnell, guest editor of our latest Continuum issue on Cerebrovascular Disease, to discuss these topics and much more.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr. Cheryl Bushnell, who is Continuum's guest editor for our latest issue on Cerebrovascular Disease. Dr. Bushnell is a professor of neurology and the director of the Center for Transformative Stroke Care at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, where she specializes in the care of stroke patients and their social and functional determinants of recovery and health, and is an internationally recognized expert on those topics. Dr. Bushnell, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Bushnell: Absolutely. Thank you for the invitation. It's really an honor to be here. So, as you mentioned, I am the director of the Center for Transformative Stroke Care at Wake Forest. It's a really fun transition for me to be involved with different care models for stroke, and I think a lot of the Continuum topics are directly relevant to some of the things that I'm doing now as an administrator and sort of a facilitator of new research. So, thanks again for having me.  Dr Jones: Yeah, and, and you have a wonderful perspective, and we're gonna pull that out today in our interview questions, and I'm looking forward to sharing that with our listeners. But before we get to the questions, we're gonna start off today's podcast with another Continuum Audio trivia question for our listeners. Anticoagulation has played a critical role in secondary ischemic stroke prevention for a long time now. While direct oral anticoagulants have taken on a greater role in the treatment of prevention of stroke, there are still some use cases for vitamin K antagonists like warfarin. The trivia question for our listeners is this: How was warfarin discovered, and how did it get its name? Stick around and we'll share the answer to that question toward the end of our interview today. So, Dr. Bushnell, let's get right to it. You alluded to your various roles, and your leadership in the field has been exemplary. The interventions for acute ischemic stroke have really exploded over the last decade or so, and they get a lot of attention and discussion, but prevention and recovery are just as important in the care of these patients. Tell us a little more about how you approached this issue, about the article topics you chose, etc.  Dr Bushnell: Well, once I was chosen to lead the guest editorship, I wanted to come up with a group of topics that were maybe a little bit different from previous issues. So, I kind of looked at the previous issues and saw, as you said, an emphasis on acute stroke, and that's really important because it has been evolving. But my thought was, how about what happens to patients after they get the intervention and they're discharged home? And because a lot of trainees may not get to see these patients ever again, or it's months before they might see them, or if they're readmitted, which is what we don't want to see, but that certainly is a lot of the exposure is in the inpatient setting. So, I thought I would kind of transport the education into the outpatient and transitional setting, as well as prevention, not only secondary, but primary prevention, with an emphasis on brain health. Some of the populations that may not get as much attention. So, sex differences, stroke in women, pregnancy, the transitions of care, and also the emphasis on holistic view of patients and their challenges, which includes the non-medical factors that drive health, otherwise known as social determinants of health.  Dr Jones: I appreciate that perspective, and obviously th-this is an area of your deep expertise, and it's great to have an issue that really digs into some of those topics a little more deeply. As an educator, I'm really glad you mentioned that about the trainee's perspective. You know, especially junior neurology trainees that are in the hospital all the time. They're seeing patients in the middle of a cerebrovascular catastrophe. But there's a long tail of recovery, right? And they'll get to see that in continuity clinic, but it's a good message to share from an evidence and, um, experiential perspective in the issue. So, appreciate that perspective. You've just read all these articles and edited them. Was there anything that you ran across that was a surprise to you?  Dr Bushnell: Well, I personally chose a lot of the authors based on my knowledge of their work. So, I wouldn't say that it was completely surprising, but I do think that I was just genuinely impressed with the quality of the writing and the synthesis of information. I just was incredibly proud of the work that these co-authors have put together. I'd say that that was-- it wasn't surprising so much as just a sense of pride that I had with the product that's coming out. But of course, there have been some new trials that had to be incorporated at the last minute, some of which were presented at the International Stroke Conference just a few weeks ago.  Dr Jones: Yeah. We try to be as up-to-date as we can, and I will completely agree with you. We have some really good writers in our field, and it's really just a pleasure when you read an article that's by an expert, and it's a joy to read. I can tell you it's one of the best parts of this job, and you get to learn a lot. I think one of the more challenging scenarios that I hear about from colleagues in recent years has been optimal management of patients with asymptomatic extracranial atherosclerosis. The pivotal trials that inform how we manage those patients were from a long time ago, decades ago, predating a lot of the more intensive medical management tools that we have today. In that scenario, Dr. Bushnell, what's the latest on that, and what should our listeners know?  Dr Bushnell: Well, obviously, the CREST 2 trial has been long awaited. It's been going on for over ten years, I believe. Of course, it's, uh, two different trials all in one, the carotid stenting and angioplasty versus intensive medical management. And of course, each of the carotid vascularization arms of the trial also had intensive medical management. And then the other trial is the carotid endarterectomy as the form of revascularization. And it interestingly did not show any benefit of carotid endarterectomy compared to intensive medical management. But of course, the somewhat surprising result was that carotid angioplasty and stenting truly was superior, although it was a small number of events in the trial overall. But that stenting plus intensive medical management was somewhat better than intensive medical management alone. And I think stenting has come a long way in terms of safety, and so I think that's been part of the evolution of the field. I do wanna say that I'm a huge fan of the intensive medical management, and I think that what the protocol does in terms of blood pressure management, cholesterol management is very much above and beyond what's done in private practice even. And the health coaching for all the other things related to diabetes and weight loss and smoking cessation and physical activity, that is what we need to be doing to actually decrease the risk of stroke, and I think that it's very effective. I can't say enough about the design of the study for that reason, that everyone gets the intensive medical management, and then you just layer on the type of revascularization on top of it. So, I wouldn't have been surprised if this was a completely negative trial overall. They just happened to have some better outcomes in the stenting arm.  Dr Jones: I recall a few years ago when the series of endovascular therapy trials for acute stroke came out, and I think there was a, a period of time where the field had to adapt to that. I wonder what you think about with the CREST 2 findings on stenting. I mean, is that gonna be a big change? Because obviously atherosclerosis is highly prevalent. Is that gonna be a big change? Is the field ready for that? How much adjustment do we have in store?  Dr Bushnell: I'm not sure it's gonna be a really big change. If you read the editorial that accompanied the trial in the New England Journal, just a few patients in either direction would have changed the outcome. I kind of look at it as an absolute difference that's relatively small. So, I'm not sure that it will have a huge impact on the field. I do think that the specialists who insert the stents may have some differences of opinion of who should be stented and who shouldn't. Because I think, you know, all of the specialists who do procedures were involved with the trial. But I would say there's a larger percentage of vascular surgeons who were involved, and so I'd say they may have a change of their practice. And neurologists may not even get involved at all.  Dr Jones: Right.  Dr Bushnell: That was one of the challenges for getting patients in the trial is that, you know, not all of us see the asymptomatic carotid stenosis, that they tend to get referred to vascular surgery. So, I think maybe in a corner of the practices of vascular surgeons is where you might see the differences.  Dr Jones: Your point about the way the trial was designed or the trials were designed, that intensive medical management is really important, and we have huge gaps in that. In our specialty, it's, you know, we have probably an opportunity in primary care even to address that. And that leads me to my next question. You know, given your perspective and your expertise, what do you think is the biggest practice gap in the care of patients with stroke or with cerebrovascular disease of any kind?  Dr Bushnell: I think by far the biggest gap is transitions of care and access to follow-up in a specialty clinic after discharge and continuous secondary prevention. We only call it secondary prevention because it happened to come after a stroke, but I really feel like we should just focus on prevention and call it that. There are a lot of people who are trying to kind of, get us away from primary versus secondary prevention. And, and Mitch Elkind is phenomenal and had a beautiful chapter weaving in prevention and brain health. So, I highly recommend that people, if they don't read any other chapters of the Continuum to read his, because I think that it's getting to your point about where the gaps are, and I think prevention is the biggest one. I think we could do so much more in models of care to ensure that there is a pathway once patients are discharged. We have no quality metrics. We have no measurement of how well people are doing after they're discharged. We have all of these fancy things and sophisticated acute treatments, but all of those are for naught if somebody goes home and they fall and they have a severe head injury or hip fracture because they weren't properly supervised or they didn't have the help that they needed at home. So, you got me on my soapbox here for a second, but that is definitely what I see as the gap.  Dr Jones: That's an important soapbox, an important gap, and obviously, if it was a simple problem, we could solve it. But it's obviously something that education is a valuable tool for that, and that's part of why we are including so much content in this issue of Continuum. So, if we put that aside as a gap that we would love to close, when you look into the near future or distant future, Dr. Bushnell, and what's the next big thing on the horizon? New interventions, new prevention tools, or something else entirely? What do you think?  Dr Bushnell: There are two things that I would mention. One is sort of the new category of anticoagulants, antithrombotics, the factor XIa inhibitors. We had an amazing presentation of the oceanic stroke trial at the International Stroke Conference, and this is probably going to be a game changer for the arsenal of antithrombotic therapies that we can offer to patients that do not have a reason for anticoagulation. So, they, they don't have atrial fibrillation, for example, or something else that requires anticoagulation. And so, the factor XI, asundexian, is the drug that they used in that trial. The safety profile is pretty amazing. There was very little bleeding complications and a great benefit in those patients with some degree of atherosclerosis, but, you know, of course, not enough to require carotid revascularization, but then also, um, small vessel disease and cryptogenic stroke. I think those are the three categories of patients, and that's a lot of the strokes that we see all benefited from this new drug. So, I think that's gonna be exciting. There, of course, it has to go through the FDA approval process, and so it might take a little bit of time before that's on the market, and we don't know how much it's gonna cost, but I think it is a, a major breakthrough. And of course, there are other similar medications in that category that are coming. And then I think the other thing is the emphasis on brain health and lifestyle factors and the things that we can do to prevent stroke and dementia because they are the same, essentially. Those are really important. And when we have someone in the hospital with a stroke or a TIA in particular, it's a great teaching opportunity for those patients to say, "Hey, here's what you can do to protect your brain." These are things that we always tell people to prevent a stroke, but just think about it as protecting your brain and keeping your brain as healthy as possible.  Dr Jones: That's a great message, and one that you get to share with patients directly. You're joining us today for this interview. You're on stroke service, so you're actively involved in caring for patients with stroke. What in your practice is the most rewarding aspect of caring for these patients? What is it that you find most rewarding?  Dr Bushnell: I've been involved in a clinical trial that has focused on managing blood pressure and also coaching and other aspects of stroke recovery. I think that has probably been the most rewarding aspect of my career. Until I was involved with this trial, I didn't necessarily do intensive blood pressure monitoring, but I'm seeing the benefits of having data from home, what those blood pressures are over a span of time. I see the immediate or intermediate effects of the blood pressure medication changes that I've made, and I see how the patients respond. So, I have to say that this is not part of usual practice, but I think it should be. And I think it's been incredible from the perspective of a neurologist who is really intensively trying to make the patients' lives better. And it's not just what I do, it's what the health coaches do as part of this intervention. And again, very similar to intensive medical management. So, I, I feel like I've been living it in a slightly different setting than in the CREST 2 trials. But there are other trials that have used the intensive medical management as approach as well. But I would say that's the most rewarding. I've seen people who've lost weight, who are physically fit, who are able to get off of blood pressure medications practically by the end of six months, and that's amazing. And then they continue doing it because they see the benefits.  Dr Jones: You've had a front row seat to a lot of that. That's really got to feel rewarding.  Dr Bushnell: It is, absolutely.  Dr Jones: You know, when you put it that way, it makes me want to go home and check my blood pressure, which I haven't done in a while. But I think that's a message to all of our listeners that we do have plenty of opportunity for risk factor optimization and following the evidence that has been generated and is being generated. Huge opportunity, not only at the population level, but I think the, um, individual patient level too. Okay, so now we're back to our Continuum Audio trivia question, and I'll repeat it for our listeners. How was warfarin discovered, and how did it get its name? Dr. Bushnell and I were talking about this earlier, so I'll just go ahead and share the answer. So, in the early 20th century in the U.S. Midwest, there were epidemics of a hemorrhagic disease in cattle, of all places, and this was eventually traced to moldy cattle feed that was made from sweet clover. And in 1940, researchers at the University of Wisconsin discovered that the anticoagulant in the sweet clover was a compound that was later synthesized for therapeutic use in 1954 as warfarin. And the name came from, uh, the support for the research. The research support came from the Wisconsin Alumni Research Foundation, or WARF, and the end of the word came from the underlying compound, which was coumarin. So that was a little bit of trivia that I had never heard. It's not in the issue, everyone, so you're getting something extra here on the podcast. But been using the drug forever. It still has its uses, even though it's become less advantageous than some of the newer agents. But-- And of course, Dr. Bushnell already knew that when I brought it up, but I just thought that was an interesting bit of history. Well, Dr. Bushnell, thank you for joining us. Thank you for such a great conversation about the latest in cerebrovascular disease. I learned a lot today. I learned a lot in reading these wonderful articles. I hope our listeners learned a lot today as well. I'm really grateful for your hard work on the issue, which I think will come in handy for junior readers and subscribers, as well as our more experienced neurologists as well. Sometimes it's hard to keep up with a rapidly changing subspecialty of our field. So, thank you for joining us today.  Dr Bushnell: Thank you for having me. It's been my pleasure.  Dr Jones: Again, today we've been speaking with Dr. Cheryl Bushnell, guest editor of Continuum's most recent issue on cerebrovascular disease. Please check it out, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

This week's topics include duration of dual anticoagulation following bypass grafting or stents, how has management of miscarriage changed, at home rehab after an ICU stay, and weight loss for atrial fibrillation.

This late-breaking sub-analysis from the CHAMPION-AF trial evaluated outcomes of left atrial appendage closure (LAAC) with the WATCHMAN FLX device versus oral anticoagulation in patients with atrial fibrillation who had previously undergone catheter ablation. Investigators found that LAAC provided similar protection against stroke, cardiovascular death, and systemic embolism compared with non-vitamin K oral anticoagulants (NOACs), while significantly reducing non-procedural bleeding events, regardless of prior ablation status. These findings suggest LAAC may be a viable alternative to long-term anticoagulation in select post-ablation AF patients through a shared decision-making approach. Join Digital Education Committee member Sandeep A. Saha, MD, MS, FHRS and his colleagues Scott C. Brancato, MD, FHRS and Rakesh Gopinathannair, MBA, MD, FHRS for this late-breaking coverage from Heart Rhythm 2026 in Chicago!   Learning Objectives Review the rationale for left atrial appendage closure as an alternative to long-term oral anticoagulation in patients with atrial fibrillation following catheter ablation. Analyze the CHAMPION-AF sub-analysis outcomes comparing LAAC and NOAC therapy with respect to stroke prevention, cardiovascular outcomes, and bleeding risk. Discuss how these findings may influence patient selection and shared decision-making for stroke prevention strategies in post-ablation atrial fibrillation care.    Podcast Contributors Sandeep A. Saha, MD, MS, FHRS Scott C. Brancato, MD, FHRS Rakesh Gopinathannair, MBA, MD, FHRS    Host and Contributor Disclosure(s): S. Brancato Nothing to disclose. R. Gopinathannair Board/Advisory Committee Membership: Heart Rhythm Society, AltaThera Pharmaceuticals Honoraria/Speaking/Teaching/Consulting: Abbott, Johnson and Johnson, Boston Scientific, Sanofi S. Saha Board/Advisory Committee Membership: Medtronic Honoraria/Speaking/Teaching/Consulting: Medtronic 

This April 2026 Heart Rhythm Journal publication reports a sub-analysis of the CHAMPION-AF trial evaluating left atrial appendage closure (LAAC) versus oral anticoagulation in patients with atrial fibrillation who previously underwent catheter ablation. The analysis demonstrated that LAAC with the WATCHMAN FLX device provided comparable protection against stroke, systemic embolism, and cardiovascular death when compared with NOAC therapy, while also reducing long-term non-procedural bleeding events. These findings support consideration of LAAC as an alternative stroke prevention strategy in selected post-ablation AF patients through individualized, shared decision-making. Digital Education Committee Member Danesh Kella, MBBS, FHRS discusses this article from the Heart Rhythm Journal that preceded the Heart Rhythm 2026 Late-Breaking Clinical Trial. He is joined in the conversation by Jason T. Jacobson, MD, FHRS, Ammar M. Killu, MBBS, and Gregory M. Marcus, MD, FHRS.   Learning Objectives Describe the rationale for left atrial appendage closure as an alternative to chronic oral anticoagulation in patients with atrial fibrillation after catheter ablation. Review the efficacy and safety outcomes from the CHAMPION-AF sub-analysis comparing LAAC and NOAC therapy in post-ablation AF patients.  Discuss patient selection considerations and the role of shared decision-making when choosing stroke prevention strategies following AF ablation.    Podcast Contributors Danesh Kella, MBBS, FHRS Jason T. Jacobson, MD, FHRS Ammar M. Killu, MBBS Gregory M. Marcus, MD, FHRS    Host and Contributor Disclosure(s): J.T. Jacobson •Board/Advisory Committee Membership: Abbott Medical •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, Vektor Medical, Inc. •Research: CardioFocus, Inc., Johnson and Johnson •Stocks, Privately Held: Atlas 5D D. Kella •Honoraria/Speaking/Teaching/Consulting: Zoll Medical Corporation, MBW Spectrum A. Killu •Board/Advisory Committee Membership: Boston Scientific •Honoraria/Speaking/Teaching/Consulting: AtriCure, Inc., Abbott, Biosense Webster, Inc., Siemans Healthineers •Research: Boston Scientific, Access Point Technologies G.M. Marcus •Honoraria/Speaking/Teaching/Consulting: InCarda Therapeutics •Research: NIH, PCORI, TRDRP •Stocks, Publicly Traded: InCarda Therapeutics  

Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.sensible-med.com/subscribe

Welcome to the first episode in this week's triple-header of late-breaking clinical trial coverage from Heart Rhythm 2026 in Chicago. In this episode Melissa E. Middeldorp, MPH, PhD from the Digital Education Committee sits down with David H. Birnie, MD and T. Jared Bunch, MD, FHRS to talk through this exciting late breaker. This late-breaking substudy of the ALONE-AF trial presented at Heart Rhythm 2026 evaluated whether discontinuing oral anticoagulation (OAC) after successful atrial fibrillation ablation impacts cognitive function in patients without long-term recurrence. The findings suggest that stopping OAC approximately one year post-ablation does not adversely affect cognitive outcomes, with cognitive scores improving similarly in both discontinuation and continuation groups among patients who remained arrhythmia-free. These results support the potential safety of OAC discontinuation in selected patients, while addressing an important gap in post-ablation management. Learning Objectives Understand the clinical rationale and current uncertainty surrounding continuation versus discontinuation of oral anticoagulation after successful AF ablation. Evaluate the impact of anticoagulation discontinuation on cognitive function in patients without recurrent atrial fibrillation. Apply emerging evidence from ALONE-AF and related studies to inform individualized decision-making on long-term anticoagulation management post-ablation.   Podcast Contributors Melissa E. Middeldorp, MPH, PhD David H. Birnie, MD T. Jared Bunch, MD, FHRS   Contributor Information: M. Middeldorp Nothing to disclose. D. Birnie Nothing to disclose.  T.J. Bunch • Honoraria/Speaking/Teaching/Consulting: Heart Rhythm Society, Pfizer  

With Maria Generosa Crespo-Leiro, Eduardo Barge-Caballero and David Couto-Mallon, University Hospital A Coruna, A Coruna - Spain. Link to paper Link to editorial

This week we review a recent Australian prospective assessment of aspirin resistance in children undergoing heart surgery. How common is this seen in this patient group and what are the reasons? What is the best test to perform to assess this and what tests may not be worthwile? Who deserves 'routine' testing for this possible problem? Cardiovascular surgeon Dr. Supreet Marathe of Queensland Children's Hospital in Brisbane, Australia shares the results of this recent publication. DOI: 10.1016/j.jtcvs.2025.09.013

John Mandrola offers an ACC recap of 5 big trials—Hi-PEITHO, PROTAVI, ORBITA-CTO, CHIPS-BCIS3 and CHAMPION AF This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Catheter Based Fibrinolysis of Pulmonary Embolism –Hi PEITHO Fibrinolysis Treatment Validated in Large Trial for Acute Intermediate-Risk PE https://www.medscape.com/viewarticle/fibrinolysis-treatment-validated-large-trial-acute-2026a10009im Ultrasound-Facilitated, Catheter-Directed Fibrinolysis for Acute Pulmonary Embolism (HI PEITHO) https://www.nejm.org/doi/full/10.1056/NEJMoa2516567 National Early Warning Score (NEWS) https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/ II PRO-TAVI trial Deferral of percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation (PRO-TAVI) 10.1016/S0140-6736(26)00308-9 External Link PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation (Notion 3) https://www.nejm.org/doi/full/10.1056/NEJMoa2401513 III ORBITA CTO Sham vs PCI for Angina Relief Tightly Blinded Trial Confirms PCI Reduces Angina in Obstructive Occlusion https://www.medscape.com/viewarticle/tightly-blinded-trial-confirms-pci-reduces-angina-2026a10009ob A Randomized, Placebo-Controlled Trial of Chronic Total Occlusion Percutaneous Coronary Intervention in Stable Angina - ORBITA-CTO https://www.jacc.org/doi/10.1016/j.jacc.2026.03.027 ORBITA 1 10.1016/S0140-6736(17)32714-9 External Link ORBITA 2 https://www.nejm.org/doi/full/10.1056/NEJMoa2310610 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 EuroCTO https://doi.org/10.1093/eurheartj/ehy220   IV CHIPS BCIS3 Impella Supported High-Risk PCI Adoption Before Evidence: CHIP-BCIS3 Humbles Impella https://www.medscape.com/viewarticle/adoption-before-evidence-chip-bcis3-humbles-impella-2026a10009jh Left Ventricular Unloading in High-Risk PCI (CHIP BCIS3) https://www.nejm.org/doi/full/10.1056/NEJMoa2515704 Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock (DanGer Shock) https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 V CHAMPION AF – Watchman vs DOAC in Patients With AF CHAMPION-AF Trial Finds LAAC an Alternative for NOAC in Lower-Risk Patients https://www.medscape.com/viewarticle/champion-af-trial-finds-laac-alternative-noac-lower-risk-2026a10009ij Six Reasons Why CHAMPION-AF Should Not Change Practice https://www.medscape.com/viewarticle/six-reasons-why-champion-af-should-not-change-practice-2026a10009i7 Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation (CHAMPION AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2517213 Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE AF) https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 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's podcast covers three NEJM trials. First, apixaban showed over 50% less clinically relevant bleeding than rivaroxaban in acute venous thromboembolism patients, with similar efficacy. Second, romiplostim helped 84% of patients on oxaliplatin-based chemotherapy avoid dose modifications due to thrombocytopenia, versus 36% with placebo. Third, inhaled treprostinil slowed lung function decline in idiopathic pulmonary fibrosis patients over 52 weeks, though cough and discontinuation rates were higher.

We are unbelievably excited this week to be reviewing the hot-off-the-presses 2026 Multi-Society (AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN) Pulmonary Embolism Guidelines with lead author Dr. Mark A. Creager. We will talk about key updates in these guidelines compared to prior practice, including the new risk classification model, and provide an overview from diagnosis to follow-up. Given the clinical importance and prevalence of pulmonary embolism, these guidelines are certainly going to shape practice going forward, so this episode is a can’t miss! Watch the full video of this episode with graphics and helpful teaching visuals on our YouTube channel: https://www.youtube.com/@pulmpeeps Meet Our Guest Dr. Mark Creager is a Professor of Medicine at Dartmouth Hitchcock Medical Center where he specializes in Cardiovascular Medicine with an emphasis on venous thromboembolic disease. He served as the lead author of the 2026 Pulmonary Embolism Guidelines. Article and Reference Creager MA, Barnes GD, Giri J, Mukherjee D, Jones WS, Burnett AE, Carman T, Casanegra AI, Castellucci LA, Clark SM, Cushman M, de Wit K, Eaves JM, Fang MC, Goldberg JB, Henkin S, Johnston-Cox H, Kadavath S, Kadian-Dodov D, Keeling WB, Klein AJP, Li J, McDaniel MC, Moores LK, Piazza G, Prenger KS, Pugliese SC, Ranade M, Rosovsky RP, Russo F, Secemsky EA, Sista AK, Tefera L, Weinberg I, Westafer LM, Young MN. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2026 Feb 19:S0735-1097(25)10161-7. doi: 10.1016/j.jacc.2025.11.005. Epub ahead of print. PMID: 41712898. Key Learning Points Why these guidelines matter: This is the first joint AHA/ACC clinical practice guideline specifically on acute PE, bringing together a truly multidisciplinary writing committee (cardiology, pulmonology, hematology, emergency medicine, interventional radiology, surgery, and others). Prior guidelines existed from individual societies, but nothing this comprehensive had been updated in roughly five to six years. New PE clinical categories (A through E): One of the most impactful changes is replacing the old “massive/submassive” and “low/intermediate/high risk” labels with five categories that form a severity continuum. Category A is subclinical (incidental PE found on imaging in asymptomatic patients). Category B covers symptomatic but low-severity patients. Category C is where much of the clinical complexity lives — symptomatic, hemodynamically stable patients subdivided into C1, C2, and C3 based on RV function and biomarkers. Category D represents incipient cardiopulmonary failure (transient hypotension, normotensive shock with end-organ dysfunction). Category E is frank cardiopulmonary failure, with E2 being the sickest — refractory or recurrent cardiac arrest. Respiratory modifiers (hypoxia requiring supplemental oxygen) layer onto C, D, and E. Diagnostic approach: Clinical evaluation comes first — history, exam, and validated decision tools (Wells score, revised Geneva, PERC). If clinical probability is low and D-dimer is normal, imaging can be safely avoided. If either is concerning, imaging is warranted. CTPA remains the preferred imaging modality due to superior sensitivity, specificity, wide availability, and ability to assess clot burden and alternative diagnoses. VQ scanning is still appropriate when CTPA is contraindicated, and VQ SPECT offers better reproducibility and specificity than traditional planar VQ if available. Echocardiography is not a diagnostic test for PE but is important for risk stratification — RV size, TAPSE, and tissue Doppler measures all contribute prognostic information. Anticoagulation updates: Anticoagulation remains the cornerstone of treatment. For patients potentially needing advanced therapies (C3, D, E), parenteral anticoagulation is started first. A notable recommendation: low molecular weight heparin is generally preferred over unfractionated heparin, based on evidence showing more effective VTE risk reduction, more predictable pharmacokinetics, no need for routine monitoring, lower rates of heparin-induced thrombocytopenia, and no increase in major bleeding. The committee acknowledged this may create discomfort for clinicians accustomed to unfractionated heparin’s easy reversibility, but the difficulty of achieving and maintaining therapeutic levels with UFH was a significant concern. Advanced therapies: Catheter-based thrombolysis, mechanical thrombectomy, systemic thrombolysis, and surgical embolectomy all received mostly class 2B recommendations (“can consider”) for C3 and D categories, reflecting that current evidence shows improvement in short-term surrogate measures (RV/LV ratio, hemodynamics) but lacks definitive hard outcome data on mortality. For category E1 patients, recommendations are stronger (class 2A). Multiple trials are expected soon — HI-PEITHO, PEERLESS-2, PE-TRACT, PERSEVERE, TORPEDO, and PROG — that should substantially inform future updates. PERT teams: Pulmonary embolism response teams are encouraged, particularly for C3, D, and E patients. They’ve been shown to reduce length of stay. For institutions without PERT capability, establishing consultation networks with larger centers is recommended. Post-PE follow-up: Patients shouldn’t be “left in the wilderness” after discharge. The guidelines recommend communication within the first week to ensure understanding of diagnosis and treatment, an in-person visit at or before three months to assess for persistent symptoms and discuss anticoagulation duration, ongoing surveillance for chronic thromboembolic pulmonary disease, and periodic reassessment for those on extended anticoagulation. Infographics

This episode discusses common inherited thrombophilias and anticoagulation therapies in pregnancy. (Originally released May 2020) Twitter: @creogsovercoff1  Instagram: @creogsovercoffee  Facebook: www.facebook.com/creogsovercoffee  Website: www.creogsovercoffee.com  Patreon: www.patreon.com/creogsovercoffee   

Research scientist Dr. Bethany Samuelson Bannow talks bodily autonomy, calls for the need for better menstrual tracking methods for individuals with bleeding disorders, and reveals how medical school training often provides minimal education on the period. She encourages listeners to speak openly about their periods to break the stigma, noting that even within religious texts, there are accounts of individuals seeking and receiving healing for heavy bleeding.   Program Notes:   Episode Links: Dr. Bannow https://www.ohsu.edu/providers/bethany-samuelsonbannow-md-mcr#profile-section__about-me Konika Ray Wong's Period Education Book https://girlpowerscience.com/shop/p/oneinamillionbook Dr. Bannow's paper / ASH Publications, re: Anticoagulation in Women: https://ashpublications.org/hematology/article/2022/1/467/493547/Anticoagulant-therapy-for-women-implications-for?guestAccessKey= NIH / Anticoagulation Article by Dr. Bannow https://pubmed.ncbi.nlm.nih.gov/39476970/ PDX Monthly Article about Dr. Bannow's outstanding work: https://www.pdxmonthly.com/health-and-wellness/2024/06/ohsu-menstrual-research-period-products-bethany-samuelson-bannow NBDF Video featuring Dr. Bannow: https://www.youtube.com/watch?v=kyb44gh27Og Dr. Period Hackers https://www.drperiodhackers.com/ Flow with Dr. Period Hackers https://www.youtube.com/watch?v=AuA63YI8RDU Dr. Bannow first to test menstrual blood on period products! https://www.opb.org/article/2023/08/30/ohsu-researchers-test-menstrual-products-with-blood-for-the-first-time/   FLOW Presenting Sponsor: #Takeda, visit bleedingdisorders.com to learn more.   Connect with BloodStream Media: Find all of our bleeding disorders podcasts on  BloodStreamMedia.com BloodStream on Facebook  BloodStream on Twitter  BloodStream on Instagram BloodStream on TikTok BloodStream on LinkedIn   Check out Believe Limited's Other Work: Bombardier Blood: bombardierblood.com My Beautiful Stutter: mybeautifulstutter.com/ Stop The Bleeding!: stbhemo.com The Science Fair: thesciencefair.org On the Shoulders of Giants: https://www.ontheshouldersfilm.com/ 

In this episode, Dr. Austin Rupp and I try to answer the following questions:Should patients with provoked VTE be offered long term anticoagulation if they have persistent risk factors, like obesity? Does coffee make atrial fibrillation worse (or better??)? Is age-adjusted d-dimer safe to use in DVT? Should we prescribe beta blockers after acute MI if the EF is normal?Does fish oil improve cardiovascular outcomes in patients on dialysis?What's the best approach for dialysis in patients with acute kidney injury?The articles:Extended Apixaban for Provoked VTE (HI-PRO)Coffee and Atrial Fibrillation (DECAF)Age-Adjusted D-dimer for DVT (ADJUST-DVT)Beta-blockers after MI with normal EFFish Oil in Dialysis Patients (PISCES)Conservative Dialysis in AKI (LIBERATE-D)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/VBD865. CME/MOC/NCPD/CPE/AAPA/IPCE credit will be available until February 16, 2027.Navigating the Path to Next-Generation Anticoagulation Strategies: Rising to the Challenge of Unmet Needs in SSP and AF In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from the Bristol Myers Squibb and Johnson & Johnson Alliance.Disclosure information is available at the beginning of the video presentation.

Join us as we review and appraise recent practice-changing articles on oral semaglutide for obesity, fish oil in ESRD, IV iron during infection, the new US Dietary Guidelines, & anticoagulation after ablation in AFib. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Josh Gilman, & Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Joshua Gilman, MD, & Matthew Watto MD, FACP Cover Art: Rahul Ganatra, MD MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Oral Semaglutide for obesity Fish Oil for CV risk reduction in hemodialysis patients IV Iron for iron deficiency anemia during infection New USA Dietary Guidelines Anticoagulation after catheter ablation for AF Outro Sponsor: FIGSCheck out the limited-edition Team USA collection, and get 15 percent off your first order at Wearfigs.com with code FIGSRX. Sponsor: Continuing Education CompanyVisit CMEmeeting.org/curbsiders and use promo code Curb30 for 30% off all online courses and webcasts.  Sponsor: GustoTry Gusto today at gusto.com/CURB, and get three months free when you run your first payroll.Sponsor: MDProgress For our listeners, enjoy your first month free at mdprogress.ca/promo/curbsiders

Anticoagulation therapy can feel complex, but nurses play a vital role in keeping patients safe. In this episode, we break down the key differences between warfarin and direct oral anticoagulants (DOACs), including how they work, when they're used, and what makes each unique. You'll review important monitoring parameters like INR for warfarin, renal function considerations for DOACs, major drug and food interactions, and bleeding risk assessment. We'll also cover reversal strategies and practical patient education pearls. Whether you're preparing for exams or managing patients on anticoagulation, this episode will simplify the essentials and strengthen your confidence in safely caring for patients on warfarin and DOAC therapy. Your support helps me provide more free resources like this! Consider supporting and getting more amazing pharmacology content! Head on over to meded101.com/nurse

In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Professor Paulus Kirchhoff from the University of Hamburg in Germany. They discuss the concept of device-detected atrial fibrillation and how we should approach anticoagulation in this common patient group. If you enjoy the show, please leave us a positive review wherever you get your podcasts. It helps us to reach more people - thanks! Link to published paper: https://heart.bmj.com/content/111/21/999.long

A highlight from exceptional sessions at the 2025 Midyear Clinical Meeting & Exhibition, this episode explores key points for establishing and adjusting anticoagulation management plans for complex patients. The episode discusses key considerations for anticoagulation management in multiple care settings, including ambulatory care and critical care.  The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Anticoagulation Monotherapy in Patients with Chronic Coronary Artery Disease and Atrial Fibrillation   Guest: Keri Zieminski, APRN, C.N.P., D.N.P. Host: Sharonne Hayes, M.D.   This episode of Mayo Clinic's “Interviews With the Experts” will give an overview of anticoagulation monotherapy in patients with chronic CAD and atrial fibrillation. Discussion will include a brief overview of recently published trials that highlight the use of anticoagulation monotherapy in chronic CAD with atrial fibrillation, and how to manage a patient on anticoagulation monotherapy that needs to undergo noncardiac surgery.    Topics Discussed: Why has there been a shift towards redefining antithrombotic medical therapy in patients with chronic CAD with atrial fibrillation? What's changed? Recently published trials that highlight the use of anticoagulation monotherapy in the chronic CAD + AF population. What is your process for managing a patient on anticoagulation monotherapy that needs to go for noncardiac surgery?    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.

Matt and Paul recap top pearls from a recent episode on Anticoagulation for Venous Thromboembolism with Dr. Tara Lech, PharmD. They also answer listener questions and share their picks of the week.  Picks of the week: Paul Recommends: Death Stranding 2: On the Beach (videogame) Matt Recommends: CJ Box novels about Joe Picket

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-465 Overview: Many patients with coronary artery disease take aspirin, but how should clinicians navigate management when an anticoagulant is also needed? In this episode, we review indications for therapy, explore evidence on dual use, and discuss how to counsel patients on balancing cardiovascular benefits with the risks of combination therapy. Episode resource links: Lemesle G, Didier R, Steg PG, et al. Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation. N Engl J Med. Published online August 31, 2025. https://www.nejm.org/doi/full/10.1056/NEJMoa2507532 Guest: Alan M. Ehrlich, MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-465 Overview: Many patients with coronary artery disease take aspirin, but how should clinicians navigate management when an anticoagulant is also needed? In this episode, we review indications for therapy, explore evidence on dual use, and discuss how to counsel patients on balancing cardiovascular benefits with the risks of combination therapy. Episode resource links: Lemesle G, Didier R, Steg PG, et al. Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation. N Engl J Med. Published online August 31, 2025. https://www.nejm.org/doi/full/10.1056/NEJMoa2507532 Guest: Alan M. Ehrlich, MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  

Case Discussion 124: Anticoagulation in Patients with Mitral Stenosis

Guest: Jaclyn Tomsic MD DMD FACS https://www.instagram.com/doctorjacci/   Host: Serv Wahan MD DMD https://www.drwahan.com/   Keywords extractions, dental surgery, complications, tooth mobility, dental techniques, patient comfort, dry sockets, anticoagulation, dental tools, oral surgery, Serv Wahan, Jaclyn Tomsic, Dental Influencer, Dental Podcast Summary In this conversation, Dr. Serv Wahan and Dr. Tomsic discuss the intricacies of dental extractions, focusing on techniques, tools, and complications. They explore various approaches to tooth removal, the importance of patient comfort, and the management of complications such as dry sockets and infections. The discussion also touches on the protocols for patients on anticoagulation therapy and the significance of proper communication in dental referrals. Takeaways There's no one way to take teeth out; different techniques work for different practitioners. Mobility of the tooth is crucial before extraction; it helps in the process. Using bite blocks is essential for patient comfort during extractions. Anticoagulation therapy should not be stopped for single tooth extractions. Dry sockets can be managed with specific pastes and follow-up care. Communication with patients about their dental history is vital for successful extractions. Understanding the anatomy of the tooth and surrounding structures is key to successful extractions. Using the right tools and techniques can minimize complications during extractions. Patient education on post-operative care can prevent complications like dry sockets. Experience and adaptability in techniques improve extraction outcomes.  Titles Mastering Dental Extractions: Techniques and Tips Navigating Complications in Tooth Removal Sound bites "You have to have all the sizes." "It's not a race." "I don't like fracturing teeth." Chapters 00:00 Introduction to Extractions and Complications 03:01 Approaching Extractions: Techniques and Tools 06:03 Understanding Tooth Mobility and Elevation 09:02 Sectioning Techniques for Difficult Extractions 11:54 Managing Adjacent Teeth and Crowns 15:04 The Importance of Assistant Support 17:47 Advanced Techniques for Challenging Canines 20:54 Final Resort Techniques for Root Extraction 23:59 Extraction of Anterior Teeth 30:00 Exploring Extraction Techniques and Tools 41:58 Understanding Complications in Dental Extractions 54:01 Managing Post-Extraction Care and Patient Concerns

Join Phillip Cuculich, MD and his guests Tina Baykaner, MD, MPH and Atul Verma, MD, FHRS for this lively discussion of a cutting edge topic. The ALONE-AF trial evaluated whether patients who remained free of atrial fibrillation for at least one year after catheter ablation could safely discontinue long-term oral anticoagulation. In this randomized study of more than 800 patients, stopping anticoagulation resulted in similarly low rates of stroke or systemic embolism and significantly fewer major bleeding events compared with continuing therapy. The findings suggest that, in carefully selected post-ablation patients, long-term anticoagulation discontinuation may be a safe and beneficial strategy.   Learning Objectives Evaluate the methodology and patient selection criteria of the ALONE-AF randomized trial to understand which post-ablation patients may be appropriate candidates for long-term anticoagulation discontinuation. Interpret the trial's primary and secondary outcomes to assess the comparative risks of thromboembolism and major bleeding in patients who discontinue versus continue oral anticoagulation after successful AF ablation. Discuss the clinical implications of ALONE-AF for shared decision-making, guideline considerations, and the development of individualized anticoagulation strategies following catheter ablation.   Article Authors Daehoon Kim, MD; Jaemin Shim, MD; Eue-Keun Choi, MD, Il-Young Oh, MD; Jun Kim, MD; Young Soo Lee, MD; Junbeom Park, MD; Jum-Suk Ko, MD; Kyoung-Min Park, MD; Jung-Hoon Sung, MD; Hyung Wook Park, MD; Hyung-Seob Park, MD; Jong-Youn Kim, MD, Ki-Woon Kang, MD; Dongmin Kim, MD; Jin-Kyu Park, MD; Dae-Hyeok Kim, MD; Jin-Bae Kim, MD; Hee Tae Yu, MD; Tae-Hoon Kim, MD; Jae-Sun Uhm, MD; Hui-Nam Pak, MD1; Boyoung Joung, MD; for the ALONE-AF Investigators   Podcast Contributors Tina Baykaner, MD, MPH Phillip Cuculich, MD Atul Verma, MD, FHRS   Article for Discussion

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/

Afib is on the rise with significant effects on morbidity and mortality. The stagnation of blood in the left atrium and left atrial appendage (LAA) places patients at risk for thromboembolism and stroke. By ligating or closing off the LAA, the risk can be significantly reduced. This intervention offers a valuable alternative to medication, improving safety and quality of life for patients through a minimally invasive, durable stroke prevention strategy. Learn more about the procedure and steps for referring your eligible patient. https://chads2vasccalculator.com/https://www.watchman.com/en-us-hcp/oac-alternative.html?utm_source=oth_site&utm_medium=display-direct&utm_campaign=ic-wm-us-dtr-hcp_app&utm_content=pcna_podcast_oac_alternative-n-n-n&cid=dsp10020937https://www.watchman.com/en-us-hcp/patient-selection-referrals/patient-pre-screening-tool.html?utm_source=oth_site&utm_medium=display-direct&utm_campaign=ic-wm-us-dtr-hcp_app&utm_content=pcna_podcast_patient_screener-n-n-n&cid=dsp10020938https://pcna.net/resource/afib-prepare-for-your-next-visit-discussion-guide/https://pcna.net/resource/the-beat-goes-on-living-with-atrial-fibrillation-online-interactive-patient-guide/https://pcna.net/resource/afib-and-stroke-infographic/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing Device Thrombosis Following Left Atrial Appendage Closure

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!

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.

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.  Read the related article in The Lancet.  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.