POPULARITY
11 episodes with antithrombotic therapy
11 episodes with antithrombotic therapy
6 episodes with antithrombotic therapy
2 episodes with antithrombotic therapy
2 episodes with antithrombotic therapy
2 episodes with antithrombotic therapy
2 episodes with antithrombotic therapy
2 episodes with antithrombotic therapy
2 episodes with antithrombotic therapy
Antithrombotic Therapy in ACS
Antithrombotic Therapy in CCS
Antithrombotic Therapy in AF
Antithrombotic Therapy in VTE
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.
Send us a textIn this episiode, Dr. Sheliza Halani interview Dr. Jameel Abdulrehman (Hematology, Thrombosis) about the latest recommendations in the CHEST 2021 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel ReportHost: Dr. Sheliza HalaniGuest: Dr. Jameel Abdulrehman, Hematologist, Assistant Professor at University of TorontoSound Editing: Alison LaiDo you ever feel like you can't get ahead of charting? Freed AI has an AI driven scribe for you! You can try Freed for free right now by going to getfreed.ai. Listeners can use the INTERN50 code for $50 off their first month!Support the show
Editor-in-Chief Eric Rubin and Deputy Editor Jane Leopold discuss research that was presented at the 2024 European Society of Cardiology annual meeting. Visit NEJM.org to read the latest research.
Site-Specific Antithrombotic Therapy: DESyne BDS Plus Study 12-month Outcomes
This is the third and last podcast of the Q&A series on the ESVS 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. In this last edition, we talk with Prof. Chris Twine and Stavros Kakkos about some recommendations and their underlying evidence regarding antithrombotic treatment in venous thromboembolic disease and vascular access for haemodialysis. It has been a pleasure learning from these world experts. More Q&A series on new ESVS clinical practice guidelines coming up soon. Keep tuned!
Here comes the second podcast of the Q&A series on the ESVS 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases. This time we address, with Prof. Chris Twine, evidence and recommendations for antithrombotic treatment in lower limb ischemic disease. A must!
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Norman Briffa, a cardiac surgeon from Sheffield, UK. They discuss his review paper about anti-thrombotic strategies after valve intervention, both transcatheter and surgical. If you enjoy the show, please leave us a podcast review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 or wherever you get your podcasts - it's really helpful. Link to published paper: https://heart.bmj.com/content/110/2/87.long
Here is the first of a series of Q&A podcasts on ESVS clinical practice guidelines. We start with the ESVS 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases, and, in this first release, Prof. Chris Twine clarifies the evidence underlying some recommendations on antithrombotic therapy in carotid artery disease. Key for our everyday clinical practice, don't miss it!
Commentary by Dr. Candice Silversides
Welcome to the Transatlantic series, a co-production of Audible Bleeding (a publication of the SVS) and the ESVS podcast. In today's episode, we explore the intersocietal guidelines on peripheral arterial disease in patients with diabetes and foot ulcers authored by the International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS), and the Society for Vascular Surgery (SVS). Dr. Robert Fitridge is a Professor of Vascular Surgery at University of Adelaide in Australia. He is a member of the IWGDF and is also a member of the steering committee for the Global Vascular Guideline on the management of Chronic Limb-threatening Ischaemia. Dr. Vivienne Chuter is a Professor in the Department of Podiatry at Western Sydney University and Honorary Professor in the School of Health Science at The University of NewCastle. She is a member of the IWGDF. She has published extensively on diabetic foot disease and leads a clinically based research program focusing on the prevention and management of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and for non-Indigenous Australians. Dr. Nicolaas Schaper is an emeritus professor of Endocrinology at Maastricht University Hospital in the Netherlands. Dr. Schaper was the coordinator of the European diabetic foot research consortium, Eurodiale. He is Chair of the 2023 Diabetic Foot Symposium (ISDF 2023) and is Chair of the IWGDF. Dr. Joseph L. Mills is a Professor of Vascular Surgery at Baylor in Houston, Texas. He is a member of the IWGDF. Dr. Mills is a leader in the vascular surgery global community, has served as president of the Peripheral Vascular Surgery Society, and is currently a member of the Surgery Residency Review Committee of the ACGME. Further reading and links: The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer. Global vascular guidelines for CLTI Best-CLI Engaging patients and caregivers to establish priorities for the management of diabetic foot ulcers A systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcers A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial Release of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentary Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular Diseases Results of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic events Low-Dose Aspirin for the Primary Prevention of Cardiovascular Disease in Diabetic Individuals: A Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis Diabetes, Lower-Extremity Amputation, and Death Outcomes in patients with chronic leg wounds in Denmark: A nationwide register‐based cohort study Pedal arch patency and not direct-angiosome revascularization predicts outcomes of endovascular interventions in diabetic patients with critical limb ischemia Effectiveness of bedside investigations to diagnose peripheral artery disease among people with diabetes mellitus: A systematic review. Performance of non-invasive bedside vascular testing in the prediction of wound healing or amputation among people with foot ulcers in diabetes: A systematic review. Effectiveness of revascularisation for the ulcerated foot in patients with diabetes and peripheral artery disease: A systematic review. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WIfI). Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. A vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trial. Mobile Applications: Society for Vascular Surgery Mobile App for Staging of Chronic Limb-Threatening Ischemia. European Society for Vascular Surgery Clinical Practice Guidelines Mobile Edition. Hosts: Dr. Naveed A. Rahman is a chief surgery resident at SUNY Upstate in Syracuse, NY. He will pursue a vascular surgery fellowship at the University of Maryland starting in 2024. His Doximity profile is https://www.doximity.com/pub/naveed-rahman-md. Twitter: @naveedrahmanmd Dr. Suzanne Stokmans is a fifth-year vascular surgery resident at the Isala Hospital in Zwolle, the Netherlands. Dr. Ezra Schwartz is a medical graduate from McGill University currently completing a Master of Medical Science in Medical Education at Harvard Medical School. He is an aspiring vascular surgeon and surgical education researcher. Twitter: @ezraschwartz10 Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.
Welcome to the Transatlantic Series, a co-production of Audible Bleeding (a publication of the SVS) and the ESVS podcast. In today's episode, we explore the intersocietal guidelines on peripheral arterial disease in patients with diabetes and foot ulcers authored by the International Working Group on the Diabetic Foot, the European Society for Vascular Surgery, and the Society for Vascular Surgery.Dr. Robert Fitridge is a Professor of Vascular Surgery at University of Adelaide in Australia. He is a member of the IWGDF and a member of the steering committee for the Global Vascular Guideline on the management of Chronic Limb-threatening Ischaemia. Dr. Vivienne Chuter is a Professor in the Department of Podiatry at Western Sydney University and Honarary Professor in the School of Health SCiences at The University of NewCastle. She is a member of the IWGDF. She has published extensively on diabetic foot disease and leads a clinically based research program focusing on prevention and management of diabetes-related foot disease for Aboriginal and Torres Strait Islander people and for non-Indigenous Australians.Dr. Nicolaas Schaper is emeritus professor of Endocrinology at Maastricht University Hospital in the Netherlands. Dr. Schaper was coordinator of the European diabetic foot research consortium, Eurodiale. He is Chair of the 2023 Diabetic Foot Symposium and is Chair of the IWGDF.Dr. Joseph L. Mills is a Professor of Vascular Surgery at Baylor in Houston, Texas. He is a member of the IWGDF. Dr. Mills is a leader in the vascular surgery global community, has served as president of the Peripheral Vascular Surgery Society and is currently a member of the Surgery Residency Review Committee of the ACGME.Further reading:The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes mellitus and a foot ulcer.Global vascular guidelines for CLTIBest-CLIEngaging patients and caregivers to establish priorities for the management of diabetic foot ulcersA systematic review of multidisciplinary teams to reduce major amputations for patients with diabetic foot ulcersA vein bypass first versus a best endovascular treatment first revascularisation strategy for patients with chronic limb threatening ischaemia who required an infra-popliteal, with or without an additional more proximal infra-inguinal revascularisation procedure to restore limb perfusion (BASIL-2): an open-label, randomised, multicentre, phase 3 trialRelease of the National Scheme's Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025; the impacts for podiatry in Australia: a commentaryESVS 2023 Clinical Practice Guidelines on Antithrombotic Therapy for Vascular DiseasesResults of the CAPRIE trial: efficacy and safety of clopidogrel. Clopidogrel versus aspirin in patients at risk of ischaemic eventsLow-Dose Aspirin for the Primary Prevention of Cardiovascular Disease in Diabetic Individuals: A Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis*Diabetes, Lower-Extremity Amputation, and DeathHosts: Dr. Naveed A. Rahman is chief surgery resident at SUNY Upstate in Syracuse, NY. He will be pursuing vascular surgery fellowship at University of Maryland starting in 2024. His Doximity profile is www.doximity.com/pub/naveed-rahman-md. X: @naveedrahmanmdDr. Suzanne Stokmans is a 5th year vascular surgery resident in the Isala hospital in Zwolle, the Netherlands.Dr. Ezra Schwartz is a medical graduate from McGill University currently completing a Masters of Medical Science in Medical Eduation at Harvard Medical School. He is an aspiring vascular surgeon and surgical education researcher. X: @ezraschwartz10
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
Nicolas Girard, MD (Curie-Montsouris Thorax Institute, Institut Curie, France), discusses lung cancer research he presented at ASCO 2023, including an advance in the understanding of this difficult-to-treat disease. Also Gregory Lip, MD (University of Liverpool, UK), reviews the most important updates to the CHEST clinical guidelines on antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19.Enjoy listening!Additional ReadingTatjana Potpara et al, Antithrombotic therapy in arterial thrombosis and thromboembolism in COVID-19: An American College of Chest Physicians Expert Panel Report, Chest (2023). DOI: 10.1016/j.chest.2023.06.032Let us know what you thought of this week's episode on Twitter: @physicianswkly Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com! Thanks for listening!
Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.23.29164 Stephany Mazur, MD summarizes findings from a recent article demonstrating no significant increase in image apparent hematoma, palpable hematoma, or need for post-biopsy bleeding-related intervention for patient on anti-thrombotic therapy as compared to those not on therapy. Only breast bruising was seen more frequently in patients on antithrombotic therapy as compared to those not on therapy.
In this episode of Curbside Consults, we examine the American College of Chest Physicians recent clinical practice guideline on Perioperative Management of Antithrombotic Therapy. We are joined by Dr. James Douketis, Chair in Thromboembolic Disease at McMaster University and the first author of the guideline.
HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast
In this episode, we will discuss all things peripheral arterial disease – definitions, staging, clinical presentation, risk factors, goals of therapy, and guideline-directed medication therapy recommendations including the newest evidence for the use of DOACs. Key Concepts Addressing modifiable risk factors (weight loss, smoking cessation, blood pressure and blood glucose control, dyslipidemia, structured exercise program, etc.) are recommended for the treatment of PAD. Single antiplatelet therapy with either aspirin 81 mg or clopidogrel 75 mg daily are recommended in patients to reduce stroke, MI and other vascular deaths in symptomatic (1A) and asymptomatic patients (IIa- C-EO). Rivaroxaban 2.5 mg BID, when added to aspirin 81 mg daily, is superior to aspirin alone in preventing composite outcome of stroke, MI, and CV death in PAD patients with recent revascularization surgery for PAD but increases the risk of major bleeding. In the absence of heart failure, cilostazol is effective in improving symptoms, quality of life, and increasing walking distance in patients with intermittent claudication. References Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e686–e725. https://doi.org/10.1161/CIR.0000000000000470 Criqui MH, Matsushita K, Aboyans V, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2021;144:e171–e191. https://doi.org/10.1161/CIR.0000000000001005 Alonso-Coello P, Bellmunt S, McGorrian C, Anand SS, Guzman R, Criqui MH, Akl EA, Vandvik PO, Lansberg MG, Guyatt GH, Spencer FA. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e669S-e690S. doi: 10.1378/chest.11-2307. PMID: 22315275; PMCID: PMC3278062. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017; 377:1319-1330. https://www.nejm.org/doi/full/10.1056/nejmoa1709118 Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral arterial disease after revascularization. N Engl J Med. 2020; 382:1994-2004. https://www.nejm.org/doi/full/10.1056/nejmoa2000052
In this episiode, Dr. Sheliza Halani interview Dr. Jameel Abdulrehman (Hematology, Thrombosis) about the latest recommendations in the CHEST 2021 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel ReportHost: Dr. Sheliza HalaniGuest: Dr. Jameel Abdulrehman, Hematologist, Assistant Professor at University of TorontoSound Editing: Alison LaiSupport the show
CUPOM: BLACKFRIDAYGUIA www.tadeclinicagem.com.br/guia - Conheça o Guia TdC com 7 dias grátis Um serviço de revisão e atualização continuados em clínica médica. A informação que você precisa, do jeito que você prefere. Junte-se aos mais de 800 assinantes. Assine o Guia, ganhe tempo e atualize-se sem esforço. Joanne, Kaue e Lucca conversam sobre armadilhas no tromboembolismo pulmonar (TEP): Quando pedir d-dímero e ajuste, em que momento iniciar a anticoagulação, como fazer a estratificação, quando trombolisar, qual anticoagulante iniciar, anticoagular ou não o TEP subsegmentar/assintomático e um pouco de TEP na gestante. Referências: 1. Kahn SR, de Wit K. Pulmonary Embolism. N Engl J Med. 2022 Jul 7;387(1):45-57. doi: 10.1056/NEJMcp2116489. PMID: 35793208. 2. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 54. 3. Raja AS, Greenberg JO, Qaseem A, et al. Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015; 163:701. 4. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160:e545. 5. Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation 2005; 112:e28. 6. Aujesky D, Obrosky DS, Stone RA, et al. A prediction rule to identify low-risk patients with pulmonary embolism. Arch Intern Med 2006; 166:169. 7. Becattini C, Casazza F, Forgione C, et al. Acute pulmonary embolism: external validation of an integrated risk stratification model. Chest 2013; 144:1539. 8. Righini M, Van Es J, Den Exter PL, Roy PM, Verschuren F, Ghuysen A, Rutschmann OT, Sanchez O, Jaffrelot M, Trinh-Duc A, Le Gall C, Moustafa F, Principe A, Van Houten AA, Ten Wolde M, Douma RA, Hazelaar G, Erkens PM, Van Kralingen KW, Grootenboers MJ, Durian MF, Cheung YW, Meyer G, Bounameaux H, Huisman MV, Kamphuisen PW, Le Gal G. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014 Mar 19;311(11):1117-24. doi: 10.1001/jama.2014.2135. Erratum in: JAMA. 2014 Apr 23-30;311(16):1694. PMID: 24643601. 9. Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, Hutten BA, Jaff MR, Manja V, Schulman S, Thurston C, Vedantham S, Verhamme P, Witt DM, D Florez I, Izcovich A, Nieuwlaat R, Ross S, J Schünemann H, Wiercioch W, Zhang Y, Zhang Y. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020 Oct 13;4(19):4693-4738. doi: 10.1182/bloodadvances.2020001830. PMID: 33007077; PMCID: PMC7556153. 10. Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ. 2020 Aug 5;370:m2177. doi: 10.1136/bmj.m2177. PMID: 32759284. 11. van der Hulle T, Cheung WY, Kooij S, Beenen LFM, van Bemmel T, van Es J, Faber LM, Hazelaar GM, Heringhaus C, Hofstee H, Hovens MMC, Kaasjager KAH, van Klink RCJ, Kruip MJHA, Loeffen RF, Mairuhu ATA, Middeldorp S, Nijkeuter M, van der Pol LM, Schol-Gelok S, Ten Wolde M, Klok FA, Huisman MV; YEARS study group. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017 Jul 15;390(10091):289-297. doi: 10.1016/S0140-6736(17)30885-1. Epub 2017 May 23. Erratum in: Lancet. 2017 Jul 15;390(10091):230. PMID: 28549662.
Aeryana Beaudrie-Nunn, PharmD (Twitter: @ABeaudrieRx) identifies the rationale for antithrombotic therapy following TAVR, reviews the utility of direct oral anticoagulants after TAVR considering recent clinical trial data and defines the patient context where direct oral anticoagulant use following TAVR is most appropriate. For more pharmacy content, follow Mayo Clinic Pharmacy Residency Programs @MayoPharmRes or the host, Garrett E. Schramm, Pharm.D., @garrett_schramm on Twitter! You can also connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Vision, 3rd episode: antithrombotic Tx. in bioprosthetic valves and valve repair
This week on Pharm5: What most pharmacists need to know about the newest CHEST Guidelines for Perioperative Management of Antithrombotic Therapy! Connect with us! Listen to our podcast: Pharm5 Watch us on TikTok: @LizHearnPharmD Follow us on Twitter: @LizHearnPharmD References: Douketis JD, Spyropoulos AC, Murad MH, et al. Perioperative management of antithrombotic therapy: An american college of chest physicians clinical practice guideline. Chest. August 2022. doi:10.1016/j.chest.2022.07.025 Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy. Chest. 2012;141(2). doi:10.1378/chest.11-2298
In this episode, Sophia Khattak discusses key points from a recent case report published in EHJ – Case Reports.
A conversation highlighting updates to the 2021 CHEST guideline updates on antithrombotic therapy for venous thromboembolism (VTE). 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.
In this episiode, Dr. Sheliza Halani interview Dr. Jameel Abdulrehman (Hematology, Thrombosis) about the latest recommendations in the CHEST 2021 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel ReportHost: Dr. Sheliza HalaniGuest: Dr. Jameel Abdulrehman, Hematologist, Assistant Professor at University of TorontoSound Editing: Alison Lai
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
Umbrella H&S: session 4, secondary prevention of stroke
Antithrombotic Therapy in Patients with Chronic Coronary Syndrome and in Sinus Rhythm
Management of Antithrombotic Therapy in AFib Patients Undergoing PCI
Evidenced based discussion on routine cases of cardiology in clinical practice - Antithrombotic Therapy in CCS
Antithrombotic Therapy in LV Smokey Pattern
Quick Review of ACC 2020 Expert Consensus Pathway of Antithrombotic Management
The findings of AUGUSTUS Trial
Antithrombotic regimens in CAD
Best individual antithrombotic strategy in CCS
Antithrombotic challenge in patients with COVID-19; focus on JACC State of ART review
CHEST December 2021, Volume 160, Issue 6 Lisa K. Moores, MD, joins CHEST Podcast Moderator Gretchen Winter, MD, to discuss the the latest antithrombotic therapy recommendations for for VTE disease. DOI: https://doi.org/10.1016/j.chest.2021.07.055 DOI: https://doi.org/10.1016/j.chest.2021.07.056
Join our content matter expert from Section of Ambulatory Care Practitioners at the 2020 Midyear Clinical Meeting as they compare appropriate antithrombotic regimens for patients with and without atrial fibrillation who have recently undergone transcatheter aortic valve replacement (TAVR), evaluate the role of dual antiplatelet therapy (DAPT) in patients who have recently undergone TAVR and summarize the prevention and treatment of subclinical leaflet thrombosis in these patients. 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.
Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Adam Olsen, MS, PA-C Millions of patients are treated with anticoagulants, and many more are treated with antiplatelet therapy. But when those therapies overlap with GI bleeding, what do you need to know so that your patients don't experience any problematic health outcomes? Dr. Peter Buch is discussing this topic with physician assistant Mr. Adam Olsen, who's the Department Chair and Program Director for the Master of Physician Assistant Studies Program at Sacred Heart University in Stamford, Connecticut.
Host: Peter Buch, MD, FACG, AGAF, FACP Guest: Adam Olsen, MS, PA-C Millions of patients are treated with anticoagulants, and many more are treated with antiplatelet therapy. But when those therapies overlap with GI bleeding, what do you need to know so that your patients don’t experience any problematic health outcomes? Dr. Peter Buch is discussing this topic with physician assistant Mr. Adam Olsen, who’s the Department Chair and Program Director for the Master of Physician Assistant Studies Program at Sacred Heart University in Stamford, Connecticut.
Commentary by Dr. Valentin Fuster
In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy. This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today! Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011 CPE details for GameChangers Podcast January 2021 Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting 0107-0000-21-079-H01-P 0.2 CEU/2.0 Hrs (Knowledge) Initial Release Date: 01/25/21 Expiration Date: 01/26/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices
In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy. This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today! Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011 CPE details for GameChangers Podcast January 2021 Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting 0107-0000-21-079-H01-P 0.2 CEU/2.0 Hrs (Knowledge) Initial Release Date: 01/25/21 Expiration Date: 01/26/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.
In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy.This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today!Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011CPE details for GameChangers Podcast January 2021Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting0107-0000-21-079-H01-P0.2 CEU/2.0 Hrs (Knowledge)Initial Release Date: 01/25/21Expiration Date: 01/26/24Additional CPE information is located at https://www.ceimpact.com/podcastSee omnystudio.com/listener for privacy information.
In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy. This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today! Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011 CPE details for GameChangers Podcast January 2021 Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting 0107-0000-21-079-H01-P 0.2 CEU/2.0 Hrs (Knowledge) Initial Release Date: 01/25/21 Expiration Date: 01/26/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.
Dr. Walt Biffl from Scripps Memorial Hospital La Jolla joins us on Rounds to discuss the evolution of BCVI management from the early 1990s to present day. Topics discussed include screening criteria, the diagnostic approach and imaging modalities for accurately identifying these injuries in our blunt polytrauma pateints. Grading criteria, antithrombotic therapies, and the use of endovascular stents round out this informative discussion with one of the world's leading experts on the topic. Check out the Show Notes at www.traumaicurounds.comAlso, you can find the updated 2020 EAST BCVI PMG here:https://www.east.org/education/practice-management-guidelines/blunt-cerebrovascular-injury-evaluation-and-management-of
This week's episode features author Torbjørn Omland and Senior Guest Editor Vera Bittner as they discuss the artile "Growth Differentiation Factor-15 Provides Prognostic Information Superior to Established Cardiovascular and Inflammatory Biomarkers in Unselected Patients Hospitalized with COVID-19." TRANSCRIPT BELOW: Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary, and backstage pass to the journal and its editors. We are your co-hosts, I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: I'm Dr. Greg Hundley, Director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Well, Carolyn our feature this week gets into inflammatory biomarkers in patients that have been hospitalized with COVID-19, but before we get to that, how about we grab a cup of coffee and work through some of the papers in the issue. Would you like to go first? Dr. Carolyn Lam: Absolutely. With both the coffee and the papers. So great, for this first paper, have you thought about concentric versus eccentric cardiac hypertrophy? We traditionally associate them with pressure versus volume overload respectively in cardiovascular disease, both though conferring an increased risk of heart failure. These contrasting forms of hypertrophy are characterized by asymmetric growth of the cardiac myocytes in mainly width or length respectively. However, the molecular mechanisms determining myocyte preferential growth in width versus length remain poorly understood. Dr. Carolyn Lam: That is until today's paper, and it is from Dr. Kapiloff from Stanford University, and Dr. Rosenfeld from UCSD, School of Medicine and their colleagues, and what they did was used primary adult rat ventricular myocytes, as well as Adeno associated virus mediated gene delivery in mice, to define a regulatory pathway controlling pathological myocyte hypertrophy, and they found that asymmetric cardiac myocyte hypertrophy is modulated by serum response factor phosphorylation, constituting an epigenomic switch balancing the growth in width versus length of adult ventricular myocytes In vitro, and In vivo. Dr. Carolyn Lam: Serum response factor phosphorylation was bi-directionally regulated at signalosomes organized by the scaffold protein muscle, A kinase anchoring protein beta. This newly identified molecular switch controlled a transcriptional program responsible for modulating changes in cardiomyocyte morphology that occurs secondary to pathological stressors. Dr. Greg Hundley: Very nice, Carolyn. So switches controlling this transcriptional program. Tell us a little bit, and bring us back to the clinical relevance of this and starting with that concentric versus eccentric hypertrophy? Dr. Carolyn Lam: I thought you may ask. The identification of a molecular mechanism regulating that asymmetric cardiomyocyte growth, really provides a new target for the inhibition of pathological cardiac hypertrophy. Studies in mice using these Adeno associated virus based gene therapies to modulate that signalosome, really provided proof of concept for translational potential in the treatment of pathological cardiac remodeling and prevention of heart failure. Dr. Greg Hundley: Oh, wow. Very nice, Carolyn. Well, my first paper comes to us from Professor Dirk Westermann from Hamburg, and focuses on cardiogenic shock patients, and veno-arterial ECMO, the results from the international multicenter cohort study. So Carolyn this study evaluated data from 686 consecutive patients with cardiogenic shock treated with VA ECMO with or without left ventricular unloading using an Impella, and they conducted this at 16 tertiary care centers across four countries. They examined the association between left ventricular unloading and 30 day mortality. Dr. Carolyn Lam: Huh, so what did they find? Dr. Greg Hundley: Okay. Carolyn. Well, left ventricular unloading was used in 337 of the 686 patients enrolled, and after propensity matching 255 patients with left ventricular unloading were compared with the 255 patients without left ventricular unloading. In the match cohort, left ventricular unloading was associated with lower 30 day mortality without differences in the various subgroups. However, complications occurred more frequently in patients with left ventricular unloading, like severe bleeding, which happened in 38.4% versus only 17.9% in those without unloading. There was also access-related ischemia and renal replacement therapy. Dr. Greg Hundley: So Carolyn, the take-home message from this International multi-center cohort study, is that left ventricular unloading is associated with lower mortality, and cardiogenic shock patients treated with VA ECMO, despite higher complication rates. In the absence of randomized trial data these findings support the use of left ventricular unloading and cardiogenic shock patients treated with VA ECMO, and call for further validation, ideally in a randomized controlled trial. Dr. Carolyn Lam: Very nice. Well for my next paper, Greg, it's all about desmin. Now we know that mutations in the human desmin gene caused myopathies and cardiomyopathies. Well, today's authors, Dr. Hermann and Schroeder from University Hospital Erlangen in Germany and Dr. Lilienbaum from University of Paris and France and their colleagues, report an adolescent patient who underwent cardiac transplantation, due to restrictive cardiomyopathy caused by a heterozygous R406W desmin mutation. Sections of the explanted heart were analyzed with antibodies specific to 406W-desmin, and to intercalated disc proteins. Effects of this mutation on the molecular properties of desmin were then addressed by cell transfection and In vitro assembly experiments. They further generated these desmin mutation knock-in mice haboring the orthologous form of the human, R406W-desmin. Dr. Greg Hundley: So Carolyn, what did they find? Dr. Carolyn Lam: Well, they demonstrated a novel pathomechanism in which cardiotoxic R406W-desmin, could adapt dual functional status with the abilities to integrate into the indogenous intermediate filament network, and to cause formation a protein aggregates. This R406W-desmin modified the extra sarcomeric cytoskeleton, such that desmin filaments were not anchored to desmosomes anymore. Thereby destroying the structural, and functional integrity of intercalated discs. Dr. Greg Hundley: What are the clinical implications? Dr. Carolyn Lam: Well, since these cardiotoxic desmin mutations could affect the integrity of intercalated discs, thereby inducing conduction defects and malignant arrhythmias, they suggest early implantation of pacemaker, or cardioverter defibrillator devices, may be considered to prevent certain cardiac death in patients with these mutations. Furthermore, state-of-the-art basic molecular risk stratification of desmin mutations may encompass a multidisciplinary experimental approach as exemplified by the approach taken here, which comprises assessment of the tissue pathology in conjunction with genome analysis and desmin assembly studies as well as patient mimicking cell and animal models for the In vivo validation of these mutations. Dr. Greg Hundley: Well, fantastic, Carolyn. Well, my next paper comes to us from Dr. Ravi Shah from the Massachusetts General Hospital. This study evaluated 2,330 white and black young adults, average age of 32 years, in the Coronary Artery Risk Development in Young Adults, or the cardiac study, to identify metabolite profiles associated with an adverse cardiovascular disease phenom that included, myocardial structure and function, fitness, vascular calcification, and then also mechanisms, and other cardiovascular outcomes that would occur over the next two decades. Statistical learning methods, including elastic nets and principal component analysis, and Cox regression generated parsimonious metabolite based risk scores, validated in over 1800 individuals in the Framingham Heart Study. Dr. Carolyn Lam: Wow. What did they show, Greg? Wow, that's a lot of work. Dr. Greg Hundley: Yeah. So Carolyn, the authors found two multiparametric metabolite-based scores linked independently to vascular, and myocardial health. With metabolites included in each score specifying microbial metabolism, hepatic steatosis, oxidative stress, nitric oxide modulation, and finally collagen metabolism. Over nearly 25 year median follow-up, and cardia, this metabolite based vascular score, and the myocardial score, and the third and fourth decade of life were associated with clinical cardiovascular disease. Importantly, the authors replicated these findings in 1,898 individuals in the Framingham Heart Study followed over two decades, such that young adults with poor metabolite based health scores had higher hazard ratios of future cardiovascular disease related events. Dr. Carolyn Lam: Oh wow. Greg, what an elegant study with both development and validation cohort evaluating the metabolome. Dr. Greg Hundley: Yes. Carolyn. So metabolic signatures of myocardial, and vascular health in young adulthood specify known novel pathways of metabolic dysfunction, relevant to cardiovascular disease associated with outcomes in two independent cohorts. So these data suggests that efforts to include precision measures of metabolic health in risk stratification to interrupt cardiovascular disease at an early at stage, are warranted. Dr. Carolyn Lam: Wow. So interesting. Other very interesting articles in today's issue, there's an In Depth article by Dr. Angiolillo entitled, “The Antithrombotic Therapy for Atherosclerotic Cardiovascular Disease Risk Mitigation in Patients with Coronary Artery Disease and Diabetes.” There's also Research Letters, one by Dr. Sultan on, “The Longterm Outcomes of Primary Cardiac Lymphoma” and one by Dr. Wang on, “Loss of Phosphatase and Tensin Homolog Promotes Cardiomyocyte Proliferation and Cardiac Repair Following Myocardial Infarction.” Dr. Greg Hundley: Great, Carolyn. Well, I've got a couple other articles in this issue as well. One is by Professor Ganesan Karthikeyan who has an On My Mind piece entitled an “Alternative Hypothesis to explain Disease Progression in Rheumatic Heart Disease.” Dr. Stuart Chen has an ECG challenge entitled, “Alternating QRS Duration and a Normal T-waves. What is the mechanism?” Then finally, Carolyn, a series of Letters to the Editor, one by Dr. Peterzan and the other by Dr. Mehmood regarding the prior published article, entitled “Cardiac Energetics in Patients with Aortic Stenosis and Preserved Ejection Fraction.” Well, Carolyn, how about we get onto that feature article and learn more about inflammatory biomarkers in hospitalized patients with COVID-19? Dr. Carolyn Lam: Yes. Let's go. Greg. Biomarkers are really playing an increasingly important role in cardiovascular disease, and even in the current COVID 19 pandemic, there's been a lot of news about how biomarkers such as traponin may be prognostic, and in fact, we're all wondering about maybe even newer biomarkers. In fact, today's feature discussion does bring to light one of the newest, and in fact, this is the first publication on the role of Growth Differentiation Factor 15 or GDF-15 in COVID-19. We're so pleased to be discussing this with the corresponding author, Dr. Torbjørn Omland from University of Oslo, in Norway, as well as our senior guest editor, Dr. Vera Bittner from University of Alabama at Birmingham. So welcome both. Tobjorn, could you tell us a little bit about GDF-15 and what made you look at it, and what did you find? Dr. Torbjørn Omland: Yeah, so GDF-15, that's a very interesting biomarker. It's considered a biomarker of biological aging cellular stress, and perhaps also the inflammation, and tests being studied within the cardiovascular field for some years now, and it has been shown to be a strong prognostic indicator across the cardiovascular spectrum, actually. So it is a new biomarker in one sense, but there are some data already in the cardiovascular field. Dr. Carolyn Lam: Not in COVID. So this is the first study to really look at its prognostic value in COVID 19. So congratulations Torbjorn, and if I may also to the first author, Dr. Peter Meer, a good friend as well, but please, could you tell us about your study and what you found? Dr. Torbjørn Omland: Yes. So when the COVID pandemic hit Norway in the spring, we thought that we should plan a prospective biomarker study. So we had to really fast track approval by the IRB and so forth, and we're able to actually cover most of the patients that were hospitalized in our hospital, Akershus University hospital, which is right outside of Oslo, and it's a pretty large hospital by Norwegian standards. It covers about 11% of the Norwegian population. Dr. Torbjørn Omland: So in that period, when we were including, we had 136 patients hospitalized with confirmed COVID 19, and we have biobank bank samples from 123 of these, and then there have been reports from retrospective studies, first from China, that seemed to suggest that markers like cardiac troponin, Anti-Troponin T, and Ferritin were associated with outcome, but those studies were prone to selection bias in that the measurements were performed in the most sick patients. So in this study we included all patients and then we thought we should examine a broad panel of biomarkers, and that included Interleukin 6, CRP, Procalcitonin, Ferritin, and the D-dimer Cardiac troponin, and N-terminal pro B, and GDF-15. Dr. Carolyn Lam: Wow. Thank you, Torbjorn. Even before you carry on with the results, can I just say having visited your hospital in pre-COVID days, I can only imagine what a work of love this was to do it prospectively. Any particular experiences to talk about, to get a fast-track even in the midst of to perform a well done prospective study, that must have taken a lot. Dr. Torbjørn Omland: Yes. But it's also interesting in that the whole sort of ablation on Norway was very much into this from the highest political level. Also, the decision that the older research on COVID should be prepared to retire, then the IRB had an eight hour and deadline for them to approve or not approve the study. So that's went surprisingly smoothly, I must say. Dr. Carolyn Lam: Wow, that's great. So what did you find? Dr. Torbjørn Omland: Yeah, so we found that among these biomarkers, several seem to predict outcome, and the primary end point of this study was to combined end-point of the hospitalization in the ICU, or death. We found that also markers like cardio traponin, BNP, ferritin, and the D-dimer and so forth, in univariable analysis, were very associated with outcome, but when we perform a more comprehensive, mostly variable modeling, then the prognostic value of some of these markers disappeared. In contrast, for GDF-15, it seemed to perform very strongly, both on the baseline sample, and interestingly also it increased in those reaching the primary end-point during the hospitalization. So it provided a very strong and independent information also when we adjusted for clinical risk scores, like the NEWS score. So that was a very pleasant surprise to see that there was one marker that's actually performed so well. The other marker that's also performed well was Ferritin. Dr. Carolyn Lam: Very interesting, and so the new score being the National Early Warning Score. Thank you. Verra, I really love to bring in your thoughts. I mean, could you take us behind the scenes with the editors? What did you think when you saw this paper? Dr. Vera Bittner: As you know, I mean, a lot of journals have been inundated by COVID papers, and so this one stuck out to us, because it's the first time that we had seen that anybody linked GDF-15 to a COVID population, even though it has been out in the literature for ACS, and in my prognostication, and in a healthy populations, and in chronic coronary disease populations, heart failure, and so on. So this is the first time that we've seen it applied there. Dr. Vera Bittner: Then I would echo some of the things that Torbjorn said, that we were also impressed, that it was prospective, because when you look at some of the other biomarker studies, what was prognostic in one with then not shake out the other one, because either different variables were included in the models, because the population's differed. So to have something that was representative of the population that was actually admitted to this, Norwegian Academic Hospital, stood out to us. So we're excited to get this paper basically for circulation, and hope that it also will be impetus for future research. Dr. Carolyn Lam: Thank you so much for sharing that end for helping us publish such a beautiful paper. Did you have some questions for two of your own? Dr. Vera Bittner: Yeah. So what stuck out to me is that you had this a whole crew of biomarkers, and then when you looked ultimately at the final model, there were two that were standing out, that was ferritin, and it was the GDF-15, and then when I looked at your graph, it looks like not only did these biomarkers measure different contrasts, but their time-course also seemed to be different, and so I was just wondering whether you had thought about, maybe using these to joint the model outcome, and whether we might even be able to get more information that way. Dr. Torbjørn Omland: I think that's an excellent suggestion, and as you correctly pointed out, they do have different sort of profiles and ferritin being an acute phase reactant, having various sort of dramatic early rise whereas we see that GDF-15 increased progressively during the course of hospitalization in the most severe patients. I think when combining them, is actually a great IMT that we should look further into. Dr. Carolyn Lam: Very nice. Torbjorn, if I could, I've got a couple of questions too. So 123 patients, 35 of whom had the primary outcome, right? So that may be sort of seen as, is this too small? and they're all hospitalized patients. So could I ask, what do you predict maybe seen in a larger population or outside of Norway or in a non-hospitalized population? Dr. Torbjørn Omland: So as you say, we were early with this report, but since it was submitted, there has been a couple of smaller studies that seemed to confirm our results. So that is reassuring, but of course we would like to have studied this in logical patients. We are in touch with the other biobank samples that could possibly confirm the data. So that's one obvious step. Then it's very interesting, as you say, could we sort of expand this to also apply to non-hospitalized patients? I think that it would be a very interesting hypothesis to test, and I think there's still a pretty good rationale for this. Dr. Torbjørn Omland: It's interesting that the insoluble group actually showed a correlation that when the soluble ST2 concentrations and GDF-15. So there might be that those with more susceptibility to COVID infections, actually, I thought that, that is actually reflected by GDF-15 concentrations, but the challenge is how to sort of get a representative non-hospitalized population, but interestingly, I was approached by some of the hospital staff that actually are in contact with general practitioners, and wanted sort of implement this test also for this group. Dr. Carolyn Lam: So Verra, we're really grateful that Allan Jaffe was working with you in managing this beautiful paper, and if you don't mind me cheekily paraphrasing that you said you might channel him, if you could, what would the channeled Allan Jaffe perhaps say about what's needed in this whole biomarkers fear in COVID-19? Dr. Vera Bittner: Hopefully, many. A channeling element is obviously difficult, because he is such an incredible expert on biomarkers that I can't even pretend to be able to see, that you might be thinking, but it seems to me that one thing that we could all agree on is that it would be really exciting if something like the: get with the guidelines COVID registry, could decide to measure this marker perspectively in the participating hospitals, for example. Dr. Vera Bittner: Then be able to look at this in a much, much larger population. I mean, especially with different ethnic backgrounds as well. I mean, I noticed actually to my surprise that, this Norwegian study how to fairly high proportion of Asians in the sample, but that may not be the ethnic distribution that we might see in different regions of the US, or different regions of the world. So it would be really nice to incorporate the measurement of this biomarker in much larger datasets. So things can be explored a bit further. Dr. Carolyn Lam: That's excellent, and Torbjorn, if you could channel Allan. What would you say? Dr. Torbjørn Omland: That's a difficult path, but absolutely just to me what Verra said. Then I think the importance of prospective studies in the COVID biomarker field, I think is our at most importance. Dr. Carolyn Lam: I think on behalf of both Torbjorn and I, and in fact everyone in circulation. Thank you, Verra for the amazing work that you and your team do for circulation as well. Thank you so much for making the time to share your thoughts today and thank you for that beautiful, beautiful paper both of you. Thank you. (singing). Listeners you've been listening to Circulation on the Run. Thank you for joining us from Greg and I. Don't forget to tune in again next week. Dr. Greg Hundley: This program is copyright, the American Heart Association 2020.
October 29 is World Stroke Day! Might as well know how it is best treated. This week, Jim Siegler revisits a 2017 episode on the differences between two of the most commonly prescribed post-stroke treatments, with some key updates, recent trial results, and practice-changing paradigms. Produced by James E. Siegler. Music courtesy of William Ross Chernoff’s Nomads, Steve Combs, Rui, Little Glass Men, and Peter Rudenko. The opening theme was composed by Jimothy Dalton. Sound effects by Mike Koenig and Daniel Simion. Unless otherwise mentioned in the podcast, no competing financial interests exist in the content of this episode. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES Jauch EC, Saver JL, Adams HP, Jr., Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW, Jr., Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H, American Heart Association Stroke C, Council on Cardiovascular N, Council on Peripheral Vascular D and Council on Clinical C. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013;44:870-947. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569-81. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. CAST (Chinese Acute Stroke Trial) Collaborative Group. Lancet. 1997;349:1641-9. Kennedy J, Hill MD, Ryckborst KJ, Eliasziw M, Demchuk AM, Buchan AM and Investigators F. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. The Lancet Neurology. 2007;6:961-9. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC and Investigators C. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. The New England journal of medicine. 2013;369:11-9. Hong KS, Lee SH, Kim EG, Cho KH, Chang DI, Rha JH, Bae HJ, Lee KB, Kim DE, Park JM, Kim HY, Cha JK, Yu KH, Lee YS, Lee SJ, Choi JC, Cho YJ, Kwon SU, Kim GM, Sohn SI, Park KY, Kang DW, Sohn CH, Lee J, Yoon BW and Investigators C. Recurrent Ischemic Lesions After Acute Atherothrombotic Stroke: Clopidogrel Plus Aspirin Versus Aspirin Alone. Stroke; a journal of cerebral circulation. 2016;47:2323-30. Liu L, Wong KS, Leng X, Pu Y, Wang Y, Jing J, Zou X, Pan Y, Wang A, Meng X, Wang C, Zhao X, Soo Y, Johnston SC, Wang Y and Investigators C. Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE. Neurology. 2015;85:1154-62. Collaborative overview of randomised trials of antiplatelet therapy--I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. Bmj. 1994;308:81-106. Antithrombotic Trialists C. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Bmj. 2002;324:71-86. Committee CS. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee. Lancet. 1996;348:1329-39. Ringleb PA, Bhatt DL, Hirsch AT, Topol EJ, Hacke W and Clopidogrel Versus Aspirin in Patients at Risk of Ischemic Events I. Benefit of clopidogrel over aspirin is amplified in patients with a history of ischemic events. Stroke; a journal of cerebral circulation. 2004;35:528-32. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, Leys D, Matias-Guiu J, Rupprecht HJ and investigators M. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, Cacoub P, Cohen EA, Creager MA, Easton JD, Flather MD, Haffner SM, Hamm CW, Hankey GJ, Johnston SC, Mak KH, Mas JL, Montalescot G, Pearson TA, Steg PG, Steinhubl SR, Weber MA, Brennan DM, Fabry-Ribaudo L, Booth J, Topol EJ and Investigators C. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. The New England journal of medicine. 2006;354:1706-17. Rothwell PM, Price JF, Fowkes FG, Zanchetti A, Roncaglioni MC, Tognoni G, Lee R, Belch JF, Wilson M, Mehta Z and Meade TW. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602-12. Sahlen A, Varenhorst C, Lagerqvist B, Renlund H, Omerovic E, Erlinge D, Wallentin L, James SK and Jernberg T. Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction: experiences from SWEDEHEART registry. European heart journal. 2016;37:3335-3342. Bath PM, Woodhouse LJ, Appleton JP, Beridze M, Christensen H, Dineen RA, Duley L, England TJ, Flaherty K, Havard D, Heptinstall S, James M, Krishnan K, Markus HS, Montgomery AA, Pocock SJ, Randall M, Ranta A, Robinson TG, Scutt P, Venables GS, Sprigg N and Investigators T. Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet. 2018;391:850-859. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O, Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH and Investigators A. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. The New England journal of medicine. 2019;380:1509-1524. Wang Y, Chen W, Lin Y, Meng X, Chen G, Wang Z, Wu J, Wang D, Li J, Cao Y, Xu Y, Zhang G, Li X, Pan Y, Li H, Zhao X, Liu L, Lin J, Dong K, Jing J, Johnston SC, Wang D, Wang Y and Group PPS. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. Bmj. 2019;365:l2211.
Drs. Robin Trotman of Cox Health and Inessa Gendlina of Montefiore Medical Center discuss the long-term effects of COVID-19 and how to manage recovered patients. Resources mentioned: Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network Management of post-acute covid-19 in primary care Persistent Symptoms in Patients After Acute COVID-19 COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19 Duration of Isolation and Precautions for Adults with COVID-19
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
https://www.nejm.org/doi/full/10.1056/NEJMoa1806515 -- IVC filter after a severe injury = it is ok to wait 7 days https://www.nejm.org/doi/full/10.1056/NEJMoa1904143 antithrombotic therapy with afib after a pci and 1 year == just the DOAC https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31791-X/fulltext polypill for primary prevention just might work but likely need more research https://www.bmj.com/content/366/bmj.l4570 the more you exercise the more you live-- seems like a basic concept and it is easy to understand but sadly hard to follow for many https://www.ncbi.nlm.nih.gov/pubmed/31189511 dulaglutide can save non-fatal strokes and for just 20million dollars you can help the industry make a killing in this very flawed study
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
Commentary by Dr. Valentin Fuster
Interview with Barry H. Greenberg, author of Association of Rivaroxaban With Thromboembolic Events in Patients With Heart Failure, Coronary Disease, and Sinus Rhythm: A Post Hoc Analysis of the COMMANDER HF Trial, and Marvin A. Konstam, MD, author of Antithrombotic Therapy in Heart Failure—The Clot Thickens
Interview with Barry H. Greenberg, author of Association of Rivaroxaban With Thromboembolic Events in Patients With Heart Failure, Coronary Disease, and Sinus Rhythm: A Post Hoc Analysis of the COMMANDER HF Trial, and Marvin A. Konstam, MD, author of Antithrombotic Therapy in Heart Failure—The Clot Thickens
For young patients who have no reason to clot, it's good to know which diagnostic tests you should send, when you should send them, and how they can be erroneously interpreted. Dr. Kristy Yuan, a vascular neurologist from the University of Pennsylvania, summarizes her approach in this week's clinical case. Produced by James E. Siegler and Kristy Yuan. Music by Chris Zabriskie, How the Night Came, Doctor Turtle, and Swelling. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. Be sure to follow us on Twitter @brainwavesaudio for the latest updates to the podcast. REFERENCES 1. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC and Moores L. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149:315-352. 2. Ho WK, Hankey GJ, Quinlan DJ and Eikelboom JW. Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review. Archives of internal medicine. 2006;166:729-36. 3. Cohn DM, Vansenne F, de Borgie CA and Middeldorp S. Thrombophilia testing for prevention of recurrent venous thromboembolism. The Cochrane database of systematic reviews. 2012;12:CD007069. 4. Connors JM. Thrombophilia Testing and Venous Thrombosis. The New England journal of medicine. 2017;377:1177-1187. 5. Garcia D and Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. The New England journal of medicine. 2018;378:2010-2021. 6. Mintzer DM, Billet SN and Chmielewski L. Drug-induced hematologic syndromes. Adv Hematol. 2009;2009:495863.
The American College of Chest Physicians (ACCP) recently updated their guideline recommendations for the use of antithrombotics for the prevention of stroke in patients with atrial fibrillation (aka the Chest Guidelines). Find out what's new, who shouldn't receive treatment based on the CHA2DS2-VASc score, and why the guideline panel recommends calculating a patient's SAME-TTR score. Guest Author: Dylan Lindsay, PharmD Music by Good Talk
This podcast highlights a state-of-the-art literature review published in the April 2018 issue of Otolaryngology–Head and Neck Surgery, the official journal of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Foundation. The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology–head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology–head and neck surgery in the United States. Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis. Click here to read the full article.
Commentary by Dr. Valentin Fuster
This week's episode of The Rounds Table is all about anticoagulation. Kieran Quinn and Mike Fralick cover two important studies: the latest evidence on antithrombotic therapy after percutaneous coronary intervention (PCI) and de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing PCI. In patients with acute coronary syndrome undergoing PCI, can platelet function ... The post Go with the (Blood) Flow: Antithrombotic Therapy After PCI and De-Escalation of Antiplatelet Therapy After PCI appeared first on Healthy Debate.
This week's episode of The Rounds Table is all about anticoagulation. Kieran Quinn and Mike Fralick cover two important studies: the latest evidence on antithrombotic therapy after percutaneous coronary intervention (PCI) and de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing PCI. In patients with acute coronary syndrome undergoing PCI, can platelet function ...The post Go with the (Blood) Flow: Antithrombotic Therapy After PCI and De-Escalation of Antiplatelet Therapy After PCI appeared first on Healthy Debate.
If you talk to people about the topic of thrombolysis in PE they'll tell you about the controversy of the submassive category, but there's a universal acceptance that thrombolysing massive PE's is well evidenced and straight forward. In this episode we delve back into the literature and not only explore massive PE thrombolysis, but also the gold standard to which it is judged upon, heparin. Have a listen to the podcast and as always we would love to hear your thoughts. Enjoy! Simon & Rob References & Further Reading 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism British Thoracic Society guidelines for the management of suspected acute pulmonary embolism; 2003 Antithrombotic Therapy for VTE Disease CHEST Guideline and Expert Panel Report; 2016 Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension. A Scientific Statement From the American Heart Association. 2011 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing; NICE. 2012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1438862/pdf/jrsocmed00257-0051.pdfValue of anticoagulants in the treatment of pulmonary embolism: a discussion paper. Paul Egermayer. Journal of the Royal Society of Medicine 1981. Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial. BARRITT DW. Lancet. 1960 Treatment of pulmonary embolism in total hip replacement. Johnson R. Clin Orthop Relat Res. 1977 PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2. Dalla-Volta S. J Am Coll Cardiol. 1992 Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Goldhaber SZ. Lancet. 1993 Thrombolysis Compared With Heparin for the Initial Treatment of Pulmonary Embolism. A Meta-Analysis of the Randomized Controlled Trials. Susan Wan. 2004 Massive PE and cardiogenic shock. To thrombolyse or not to thrombolyse, that is the question. Francoise Ticehurst. BestBets. 2004
Many patients with atrial fibrillation (AF) received triple antithrombotic therapy after undergoing a percutaneous coronary intervention (PCI) and receiving cardiac stent. Triple therapy consists of warfarin plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and low-dose aspirin. But is triple therapy the best approach? This practice, while widely employed, is not entirely evidence-based. Moreover, the effectiveness and safety of the direct oral anticoagulants (DOACs) in this patient population is unknown. Theme Music by Good Talk
This week, Amol talks about new antithrombotic therapy guidelines and using low calorie diet for diabetes remission. The American College of Chest Physicians issued new antithrombotic guidelines for the treatment of venous thromboembolism in February 2016. Amol highlights five updates in the guidelines, and discusses the evidence behind each recommendation. Diabetes has long been described ... The post Summer Replay: New Antithrombotic Therapy Guidelines and Low Calorie Diet for Diabetes Remission appeared first on Healthy Debate.
This week, Amol talks about new antithrombotic therapy guidelines and using low calorie diet for diabetes remission. The American College of Chest Physicians issued new antithrombotic guidelines for the treatment of venous thromboembolism in February 2016. Amol highlights five updates in the guidelines, and discusses the evidence behind each recommendation. Diabetes has long been described ...The post Summer Replay: New Antithrombotic Therapy Guidelines and Low Calorie Diet for Diabetes Remission appeared first on Healthy Debate.
This is the first in a series of monthly Guidelines podcasts. This month @AndyNeill joins @maxirebecca to discuss the recent Chest Guidelines on Antithrombotic Therapy for VTE disease
This week, Amol talks about new antithrombotic therapy guidelines and using low calorie diet for diabetes remission. The American College of Chest Physicians issued new antithrombotic guidelines for the treatment of venous thromboembolism in February 2016. Amol highlights five updates in the guidelines, and discusses the evidence behind each recommendation. Diabetes has long been described ...The post Spousal Input: New Antithrombotic Therapy Guidelines and Low Calorie Diet for Diabetes Remission appeared first on Healthy Debate.
This week, Amol talks about new antithrombotic therapy guidelines and using low calorie diet for diabetes remission. The American College of Chest Physicians issued new antithrombotic guidelines for the treatment of venous thromboembolism in February 2016. Amol highlights five updates in the guidelines, and discusses the evidence behind each recommendation. Diabetes has long been described ... The post Spousal Input: New Antithrombotic Therapy Guidelines and Low Calorie Diet for Diabetes Remission appeared first on Healthy Debate.
Clive Kearon, MD, PhD, and COL Lisa K. Moores, MC, USA, FCCP, join CHEST Evidence-Based Medicine Section Editor, Ian T. Nathanson, MD, FCCP, to review the important updates to the VTE Guidelines. This is the first of the topic updates to CHEST since the move to a "living guidelines" model, where topics will be updated on a rolling basis, not compiled into a single supplement containing all updates.
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed Guidelines from the American College of Chest Physicians
Guest: Thiruvinva Dharmarajan, MD FACP AGSF Host: Eric Tangalos, MD Patients in hospital settings are often screened and promptly treated for venous thromboembolism, or VTE, but perhaps less commonly in long-term care, even though these patients may be at risk. Dr. T.S. Dharmarajan, clinical director of the division of geriatrics at Montefiore Medical Center (North Division) in the Bronx, New York, discusses the medical conditions in long-term care that put patients at risk for VTE, and ways to assess patients for the condition. What anticoagulation medications and treatments may be used for treating VTE in long-term care? Should long-term care clinicians treat VTE as aggressively as hospitals often do, or are there other unique considerations clinicians should keep in mind for managing patients at risk for VTE in long-term care? Dr. Eric Tangalos hosts.
Why are we missing peripheral arterial disease (PAD)? How is it diagnosed using the Ankle-Brachial Index (ABI)? What treatments improve symptoms and reduce cardiovascular risks? When should revascularization be considered?** Register for 2025 Digital Education & Artificial Intelligence Conference !! **It will be an inspiring day filled with hands-on workshops and expert panels designed to empower educators with practical digital media and AI tools.Transcript and Show notesTimestamps:(02:23) | PEARL 1: When to suspect PAD? Risk factors?(07:34) | PEARL 2: How to work up PAD?(16:26) | PEARL 3: Improving symptoms and quality of life (25:38) | PEARL 4: Approach to therapy: Preventing CV mortality (33:53) | PEARL 5: Deeper Dive into Antithrombotic Therapy and Anticoagulation (39:09) | PEARL 6: Who needs revascularization? Tags: CoreIM, PAD, Peripheral Arterial Disease, ABI, claudication, vascular medicine, revascularization, internal medicine, smoking cessation, lipid management, primary care, physician assistant, nurse practitioner, cilostazol. supervised exercise therapyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy
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