Vascular disease caused by the formation of a blood clot inside a blood vessel
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Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net. Today on the emDOCs cast with Brit Long (@long_brit), we cover cavernous sinus thrombosis (CST). To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play
For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more!Half Dose DOAC for Long Term VTE Prevention (RENOVE)Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis)GPT-4 Assistance for Physician PerformanceOptimal Vasopressin Initiation for Septic Shock (OVISS)DOACs for A fib after ICH (PRESTIGE-AF)High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R
This morning on The Opinion Line, Paul Byrne was joined by Garry Minihane, an Ironman athlete who trained rigorously, never smoked, and lived an active lifestyle but still battled a series of health crises. Hosted on Acast. See acast.com/privacy for more information.
Editor's Summary by Linda Brubaker, MD, Deputy Editor of JAMA, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published from March 1-7, 2025.
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
The AZALEA–TIMI 71 trial compared abelacimab, a monoclonal antibody targeting factor XI, with rivaroxaban in atrial fibrillation patients at moderate-to-high stroke risk.
In the latest episode of our advocacy series on The Association Insights Podcast (previously The Association 100 podcast - same great content, fresh new name!), host Colleen Gallagher engages in a compelling conversation with Louise St. Germain, Director of Membership, Marketing, and External Relations at theInternational Society on Thrombosis and Haemostasis (ISTH). With over 24 years of experience in membership, marketing, and external relations, including 12 years at the ISTH, Louise shares her journey and the impactful work of the society.Key Highlights:Career Path and Early Experiences: Louise reflects on her diverse background, starting with her role at the American Red Cross during Hurricane Katrina, where she learned the importance of flexibility, resourcefulness, and building relationships. These experiences laid the foundation for her subsequent work in communications and PR for non profits and associations.The Power of Partnerships: Emphasizing that "nothing happens alone," Louise discusses the critical role of partnerships in advancing ISTH's mission. Collaborations with entities like the World Health Organization and the European Thrombosis and Haemostasis Alliance have been pivotal in extending the society's reach and impact.World Thrombosis Day Campaign: Louise dives into the success of the World Thrombosis Day campaign, an initiative she describes as akin to nurturing a child now in its 12th year. The campaign has significantly increased global awareness of blood clot risks, influenced healthcare policies, and fostered collaborations with numerous organizations and governments worldwide.Advocacy and External Relations: Louise outlines the ISTH's multi-pronged approach to advocacy, which leverages scientific evidence, expert voices, and patient stories. Engaging early and often with regulatory bodies like the FDA and EMA, and aligning with broader public health priorities, has been central to their strategy.Crisis Communication and Preparedness: Drawing from her early experiences, Louise highlights the importance of proactive crisis communication planning. She advocates for developing clear, living crisis communication response plans and bringing teams along in preparedness efforts to maintain public trust during challenging times.Adapting to Policy Changes: In light of recent changes in the U.S. administration, Louise discusses how ISTH remains agile by monitoring global policy shifts and aligning their messaging with evolving healthcare priorities. Positioning ISTH as a nonpartisan, evidence-based organization has been key to effectively engaging with policymakers.Future Trends in Advocacy and Public Affairs: Looking ahead, Louise identifies key trends such as the integration of AI and digital strategies, personalized engagement, and cross-sector collaboration. She emphasizes the importance of associations staying relevant by embracing these trends and continually innovating in their approaches.Join us for this insightful discussion as Louise St. Germain shares her experiences and strategies in association management, marketing, and advocacy, offering valuable takeaways for professionals in the field.Stay Connected:Subscribe to The Association 100 podcast onSpotify,Apple Podcasts orYouTube Podcasts to ensure you never miss an episode.Follow us on LinkedIn atOnWrd & UpWrd for the latest in association trends and strategies.Tune in next week as we continue our advocacy series with another insightful discussion to help associations navigate the evolving political landscape.
In der vierten Folge der dritten Staffel "Moleküle auf dem Teller" geht es um Vitamine, die in ihrer Vielfältigkeit wohl durchaus etwas Magisches haben, was mich zum Titel inspiriert hat. In dieser Folge erfährst Du nun also, wie die einzelnen Vitamine funktionieren, wieso Vitamin D gar kein "echtes" Vitamin ist und wieso Vitamine so wichtig für Sportler*innen aller Disziplinen sind. Außerdem gibt es am Ende bereits einen kleinen Outlook: nächste Folge kannst Du dich auf Erklärungen zu Mineralstoffen freuen! Informationen zum Podcast Recherche und Skript: Anne Mayer, mit Unterstützung von ChatGPT 4o und o1 und Perplexity AI (Pro) Ton und Schnitt: Anne Mayer
Laura Beaton chats with Paul Kubler, director of Rheumatology at Royal Brisbane and Women's hospital, about how to identify and manage antiphospholipid syndrome. They discuss the key presentations of APS, classification criteria and approaches to treatment. They also cover patients with catastrophic APS and asymptomatic people with persistent antiphospholipid antibodies. Read the full article by Paul and his co-authors in Australian Prescriber.
Send us a textBemiparin in neonatal thrombosis: therapeutic dosing and safety.Sanchez-Holgado M, Sampedro M, Zozaya C, Permuy Romero C, Alvarez-Garcia P, La Banda-Montalvo L, Nieto C, Pellicer A.J Perinatol. 2024 Dec 16. doi: 10.1038/s41372-024-02200-1. Online ahead of print.PMID: 39681735As 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!
This week we discuss blood clots A blood clot is a clump of blood that has changed from a liquid to a gel-like or semisolid state. Clotting is a necessary process that can help prevent excessive blood loss when you have a cut, for example. Thrombosis is when a blood clot forms and reduces blood flow. There are two types: Arterial thrombosis occurs when a blood clot forms in an artery. Venous thrombosis occurs when a blood clot forms in a vein. When a clot forms inside one of your veins, it may dissolve on its own. However, sometimes a clot doesn't dissolve on its own, or part of it breaks off and travels elsewhere in your circulatory system. When this happens, the blood clot may get stuck elsewhere and restrict blood flow, known as embolism. These situations can be very dangerous and even life threatening. According to the Centers for Disease Control and Prevention (CDC), 1 in 2 people don't experience any symptoms when they have a deep venous blood clot. When symptoms do appear, it's important to get immediate medical attention. Medical emergency A blood clot may be a medical emergency and life threatening if left untreated. Call 911 or go to the nearest emergency room immediately if you or someone you're with experiences symptoms of a serious blood clot, such as: sudden shortness of breath chest pressure difficulty breathing, seeing, or speaking Call a doctor or seek medical attention if you experience throbbing, swelling, and tenderness in one body part.
Guest: Dr. Christian de Virgilio is the Chair of the Department of Surgery at Harbor-UCLA Medical Center. He is also Co-Chair of the College of Applied Anatomy and a Professor of Surgery at UCLA's David Geffen School of Medicine. He completed his undergraduate degree in Biology at Loyola Marymount University and earned his medical degree from UCLA. He then completed his residency in General Surgery at UCLA-Harbor Medical Center followed by a fellowship in Vascular Surgery at the Mayo Clinic. Resources: Rutherford Chapters (10th ed.): 174, 175, 177, 178 Prior Holding Pressure episode on AV access creation: https://www.audiblebleeding.com/vsite-hd-access/ The Society for Vascular Surgery: Clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access: https://www.jvascsurg.org/article/S0741-5214%2808%2901399-2/fulltext KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update: https://pubmed.ncbi.nlm.nih.gov/32778223/ Outline: Steal Syndrome Definition & Etiology Steal syndrome is an important complication of AV access creation, since access creation diverts arterial blood flow from the hand. Steal can be caused by multiple factors—arterial occlusive disease proximal or distal to the AV anastomosis, high flow through the fistula at the expense of distal arterial perfusion, and failure of the distal arterial networks to adapt to this decreased blood flow. Incidence and Risk Factors The frequency of steal syndrome is 1.6-9%1,2, depending on the vessels and conduit choice Steal syndrome is more common with brachial and axillary artery-based accesses and nonautogenous conduits. Other risk factors for steal syndrome are peripheral vascular disease, coronary artery disease, diabetes, advanced age, female sex, larger outflow conduit, multiple prior permanent access procedures, and prior episodes of steal.3,4 Long-standing insulin-dependent diabetes causes both medial calcinosis and peripheral neuropathy, which limits arteries' ability to vasodilate and adjust to decreased blood flow. Patient Presentation, Symptoms, Grading Steal syndrome is diagnosed clinically. Symptoms after AVG creation occurs within the first few days, since flow in prosthetic grafts tend to reach a maximum value very early after creation. Native AVFs take time to mature and flow will slowly increase overtime, leading to more insidious onset of symptoms that can take months or years. The patient should have a unilateral complaint in the extremity with the AV access. Symptoms of steal syndrome, in order of increasing severity, include nail changes, occasional tingling, extremity coolness, numbness in fingertips and hands, muscle weakness, rest pain, sensory and motor deficits, fingertip ulcerations, and tissue loss. There could be a weakened radial pulse or weak Doppler signal on the affected side, and these will become stronger after compression of the AV outflow. Symptoms are graded on a scale specified by Society of Vascular Surgery (SVS) reporting standards:5 Workup Duplex ultrasound can be used to analyze flow volumes. A high flow volume (in autogenous accesses greater than 800 mL/min, in nonautogenous accesses greater than 1200 mL/min) signifies an outflow issue. The vein or graft is acting as a pressure sink and stealing blood from the distal artery. A low flow volume signifies an inflow issue, meaning that there is a proximal arterial lesion preventing blood from reaching the distal artery. Upper extremity angiogram can identify proximal arterial lesions. Prevention Create the AV access as distal as possible, in order to preserve arterial inflow to the hand and reduce the anastomosis size and outflow diameter. SVS guidelines recommend a 4-6mm arteriotomy diameter to balance the need for sufficient access flow with the risk of steal. If a graft is necessary, tapered prosthetic grafts are sometimes used in patients with steal risk factors, using the smaller end of the graft placed at the arterial anastomosis, although this has not yet been proven to reduce the incidence of steal. Indications for Treatment Intervention is recommended in lifestyle-limiting cases of Grade II and all Grade III steal cases. If left untreated, the natural history of steal syndrome can result in chronic limb ischemia, causing gangrene with loss of digits or limbs. Treatment Options Conservative management relies on observation and monitoring, as mild cases of steal syndrome may resolve spontaneously. Inflow stenosis can be treated with endovascular intervention (angioplasty with or without stent) Ligation is the simplest surgical treatment, and it results in loss of the AV access. This is preferred in patients with repetitive failed salvage attempts, venous hypertension, and poor prognoses. Flow limiting procedures can address high volumes through the AV access. Banding can be performed with surgical cutdown and placement of polypropylene sutures or a Dacron patch around the vein or graft. The Minimally Invasive Limited Ligation Endoluminal-Assisted Revision (MILLER) technique employs a percutaneous endoluminal balloon inflated at the AVF to ensure consistency in diameter while banding Plication is when a side-biting running stitch is used to narrow lumen of the vein near the anastomosis. A downside of flow-limiting procedures is that it is often difficult to determine how much to narrow the AV access, as these procedures carry a risk of outflow thrombosis. There are also surgical treatments focused on reroute arterial inflow. The distal revascularization and interval ligation (DRIL) procedure involves creation of a new bypass connecting arterial segments proximal and distal to the AV anastomosis, with ligation of the native artery between the AV anastomosis and the distal anastomosis of the bypass. Reversed saphenous vein with a diameter greater than 3mm is the preferred conduit. Arm vein or prosthetic grafts can be used if needed, but prosthetic material carries higher risk of thrombosis. The new arterial bypass creates a low resistance pathway that increases flow to distal arterial beds, and interval arterial ligation eliminates retrograde flow through the distal artery. The major risk of this procedure is bypass thrombosis, which results in loss of native arterial flow and hand ischemia. Other drawbacks of DRIL include procedural difficulty with smaller arterial anastomoses, sacrifice of saphenous or arm veins, and decreased fistula flow. Another possible revision surgery is revision using distal inflow (RUDI). This procedure involves ligation of the fistula at the anastomosis and use of a conduit to connect the outflow vein to a distal artery. The selected distal artery can be the proximal radial or ulnar artery, depending on the preoperative duplex. The more dominant vessel should be spared, allowing for distal arterial beds to have uninterrupted antegrade perfusion. The nondominant vessel is used as distal inflow for the AV access. RUDI increases access length and decreases access diameter, resulting in increased resistance and lower flow volume through the fistula. Unlike DRIL, RUDI preserves native arterial flow. Thrombosis of the conduit would put the fistula at risk, rather than the native artery. The last surgical revision procedure for steal is proximalization of arterial inflow (PAI). In this procedure, the vein is ligated distal to the original anastomosis site and flow is re-established through the fistula with a PTFE interposition graft anastomosed end-to-side with the more proximal axillary artery and end-to-end with the distal vein. Similar to RUDI, PAI increases the length and decreases the diameter of the outflow conduit. Since the axillary artery has a larger diameter than the brachial artery, there is a less significant pressure drop across the arterial anastomosis site and less steal. PAI allows for preservation of native artery's continuity and does not require vein harvest. Difficulties with PAI arise when deciding the length of the interposition graft to balance AV flow with distal arterial flow. 2. Ischemic Monomelic Neuropathy Definition Ischemic monomelic neuropathy (IMN) is a rare but serious form of steal that involves nerve ischemia. Severe sensorimotor dysfunction is experienced immediately after AV access creation. Etiology IMN affects blood flow to the nerves, but not the skin or muscles because peripheral nerve fibers are more vulnerable to ischemia. Incidence and Risk Factors IMN is very rare; it has an estimated incidence of 0.1-0.5% of AV access creations.6 IMN has only been reported in brachial artery-based accesses, since the brachial artery is the sole arterial inflow for distal arteries feeding all forearm nerves. IMN is associated with diabetes, peripheral vascular disease, and preexisting peripheral neuropathy that is associated with either of the conditions. Patient Presentation Symptoms usually present rapidly, within minutes to hours after AV access creation. The most common presenting symptom is severe, constant, and deep burning pain of the distal forearm and hand. Patients also report impairment of all sensation, weakness, and hand paralysis. Diagnosis of IMN can be delayed due to misattribution of symptoms to anesthetic blockade, postoperative pain, preexisting neuropathy, a heavily bandaged arm precluding neurologic examination. Treatment Treatment is immediate ligation of the AV access. Delay in treatment will quickly result in permanent sensorimotor loss. 3. Perigraft Seroma Definition A perigraft seroma is a sterile fluid collection surrounding a vascular prosthesis and is enclosed within a pseudomembrane. Etiology and Incidence Possible etiologies include: transudative movement of fluid through the graft material, serous fluid collection from traumatized connective tissues (especially the from higher adipose tissue content in the upper arm), inhibition of fibroblast growth with associated failure of the tissue to incorporate the graft, graft “wetting” or kinking during initial operation, increased flow rates, decreased hematocrit causing oncotic pressure difference, or allergy to graft material. Seromas most commonly form at anastomosis sites in the early postoperative period. Overall seroma incidence rates after AV graft placement range from 1.7–4% and are more common in grafts placed in the upper arm (compared to the forearm) and Dacron grafts (compared to PTFE grafts).7-9 Patient Presentation and Workup Physical exam can show a subcutaneous raised palpable fluid mass Seromas can be seen with ultrasound, but it is difficult to differentiate between the types of fluid around the graft (seroma vs. hematoma vs. abscess) Indications for Treatment Seromas can lead to wound dehiscence, pressure necrosis and erosion through skin, and loss of available puncture area for hemodialysis Persistent seromas can also serve as a nidus for infection. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines10 recommend a tailored approach to seroma management, with more aggressive surgical interventions being necessary for persistent, infected-appearing, or late-developing seromas. Treatment The majority of early postoperative seromas are self-limited and tend to resolve on their own Persistent seromas have been treated using a variety of methods-- incision and evacuation of seroma, complete excision and replacement of the entire graft, and primary bypass of the involved graft segment only. Graft replacement with new material and rerouting through a different tissue plane has a higher reported cure rate and lower rate of infection than aspiration alone.9 4. Infection Incidence and Etiology The reported incidence of infection ranges 4-20% in AVG, which is significantly higher than the rate of infection of 0.56-5% in AVF.11 Infection can occur at the time of access creation (earliest presentation), after cannulation for dialysis (later infection), or secondary to another infectious source. Infection can also further complicate a pre-existing access site issue such as infection of a hematoma, thrombosed pseudoaneurysm, or seroma. Skin flora from frequent dialysis cannulations result in common pathogens being Staphylococcus, Pseudomonas, or polymicrobial species. Staphylococcus and Pseudomonas are highly virulent and likely to cause anastomotic disruption. Patient Presentation and Workup Physical exam will reveal warmth, pain, swelling, erythema, induration, drainage, or pus. Occasionally, patients have nonspecific manifestations of fever or leukocytosis. Ultrasound can be used to screen for and determine the extent of graft involvement by the infection. Treatments In AV fistulas: Localized infection can usually be managed with broad spectrum antibiotics. If there are bleeding concerns or infection is seen near the anastomosis site, the fistula should be ligated and re-created in a clean field. In AV grafts: If infection is localized, partial graft excision is acceptable. Total graft excision is recommended if the infection is present throughout the entire graft, involves the anastomoses, occludes the access, or contains particularly virulent organisms Total graft excision may also be indicated if a patient develops recurrent bacteremia with no other infectious source identified. For graft excision, the venous end of the graft is removed and the vein is oversewn or ligated. If the arterial anastomosis is intact, a small cuff of the graft can be left behind and oversewn. If the arterial anastomosis is involved, the arterial wall must be debrided and ligation, reconstruction with autogenous patch angioplasty, or arterial bypass can be pursued. References 1. Morsy AH, Kulbaski M, Chen C, Isiklar H, Lumsden AB. Incidence and Characteristics of Patients with Hand Ischemia after a Hemodialysis Access Procedure. J Surg Res. 1998;74(1):8-10. doi:10.1006/jsre.1997.5206 2. Ballard JL, Bunt TJ, Malone JM. Major complications of angioaccess surgery. Am J Surg. 1992;164(3):229-232. doi:10.1016/S0002-9610(05)81076-1 3. Valentine RJ, Bouch CW, Scott DJ, et al. Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis. J Vasc Surg. 2002;36(2):351-356. doi:10.1067/mva.2002.125848 4. Malik J, Tuka V, Kasalova Z, et al. Understanding the Dialysis access Steal Syndrome. A Review of the Etiologies, Diagnosis, Prevention and Treatment Strategies. J Vasc Access. 2008;9(3):155-166. doi:10.1177/112972980800900301 5. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603-610. doi:10.1067/mva.2002.122025 6. Thermann F, Kornhuber M. Ischemic Monomelic Neuropathy: A Rare but Important Complication after Hemodialysis Access Placement - a Review. J Vasc Access. 2011;12(2):113-119. doi:10.5301/JVA.2011.6365 7. Dauria DM, Dyk P, Garvin P. Incidence and Management of Seroma after Arteriovenous Graft Placement. J Am Coll Surg. 2006;203(4):506-511. doi:10.1016/j.jamcollsurg.2006.06.002 8. Gargiulo NJ, Veith FJ, Scher LA, Lipsitz EC, Suggs WD, Benros RM. Experience with covered stents for the management of hemodialysis polytetrafluoroethylene graft seromas. J Vasc Surg. 2008;48(1):216-217. doi:10.1016/j.jvs.2008.01.046 9. Blumenberg RM, Gelfand ML, Dale WA. Perigraft seromas complicating arterial grafts. Surgery. 1985;97(2):194-204. 10. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4):S1-S164. doi:10.1053/j.ajkd.2019.12.001 11. Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: Recognition and management. J Vasc Surg. 2008;48(5):S55-S80. doi:10.1016/j.jvs.2008.08.067
Focus Issue on Ischemic Heart Disease, Thrombosis and Antithrombotic Therapies
Our initial review of the PLATO trial, published in April 2024, was based on the data available to us at that time. We have since became aware of new information that reduces our confidence in the PLATO results. This new information has major implications for clinical practice. Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Despite representing only 6.9% of the total P2Y12 inhibitor prescriptions among Medicare beneficiaries in 2020, Ticagrelor accounted for nearly two-thirds of total Medicare spending on these drugs in the same year. We summarize important points below but you can refer to this investigation at BMJ for more details.1. Unexplained Regional Variation: In our original review, we highlighted the treatment effect interaction based on region of enrollment, where ticagrelor was less effective compared to clopidogrel for patients enrolled in North America. It appeared to be a strong signal and was associated with a p-value for the interaction of 0.05. However, we were cautious in our interpretation since overall, patients enrolled in North America represented a relatively small fraction of total patients and we could not think of a reasonable explanation.Information in the BMJ investigation now sheds new light on these findings. In our review, we only presented data contained in the supplement accompanying the PLATO trial manuscript, which categorized patients based on region of enrollment but did not provide country specific information. The BMJ report notes that in a separate subgroup analysis, based on country of randomization, the primary outcome was numerically higher with ticagrelor in the United States (12.6% vs 10.1%, HR: 1.27, 95% CI: 0.92 – 1.75). This subgroup represented 7.6% of the total trial participants. Overall, 9.7% of trial participants were enrolled from North America. This means the US data drove the findings from the North American subgroup.The explanation provided by AstraZeneca (the manufacturer of ticagrelor) to explain the observed treatment effect heterogeneity was that aspirin dosing in the United States was higher than in other countries. It even led the FDA to issue a black box warning to avoid an aspirin maintenance dose of >100 mg in patients taking ticagrelor. An extensive statistical analysis of the regional variation in PLATO yielded four interesting points. First what was the prior likelihood of observing a ticagrelor vs clopidogrel HR of > 1.25 in the US, when the overall HR was actually equal to 0.84? That probability is ≤ 0.01. This alone suggests more than chance. Second point: a strong US/nonUS interaction was noted for each of the 3 components of the primary endpoint—CV death, MI, stroke. Third: they found a very strong interaction between treatment and median aspirin dose, and, importantly, the aspirin interaction effect was similar in US and nonUS settings. Fourth, an analysis of contract research organization (CRO) vs sponsor monitoring of the site accounted for 61% of the treatment-by- region interaction. The authors downplayed this finding because of the four countries monitored by a CRO (Israel, US, Georgia and Russia), the US made up the majority and thus is confounded by the aspirin interaction. Noteworthy was a lack of direct analysis of CRO vs sponsor test for interaction. One problem though: the BMJ investigation found that the lead author, Kevin Carroll was the head statistician at AstraZeneca and had worked at the company for 20 years. Carroll presented the PLATO results at the FDA advisory meeting. The paper lists Carroll as having no conflicts. Carroll told the BMJ that he had disposed of all conflicts of interest before submitting that analysis. But, in our opinion, the aspirin explanation does not pass muster because of biologic implausibility. See next section: How would a higher dose of aspirin reduce the efficacy of ticagrelor?The primary composite endpoint was vascular death, MI or stroke. If the higher aspirin dose impacted this, we would hypothesize that it caused more major bleeding in the ticagrelor group with some events resulting in vascular death, type 2 MI and hemorrhagic stroke, driving the treatment effect in favor of clopidogrel. But there is no evidence of this.The figure below is from the original subgroup plots provided in the PLATO supplement. The difference in the treatment effect for the primary endpoint for North American patients is striking but there is no difference for major bleeding.In our opinion and the opinion of others, the role of supervision of the centers could be important. Most centers were monitored by the sponsor. Four countries (Israel, US, Georgia and Russia) were monitored by a contract research organization. All four of these countries had numerically higher rates of the primary outcome in the ticagrelor group. This has major implications and we do not take them lightly. Essentially, it suggests malfeasance on the part of the sponsor. So is there anything else to support such a claim? Well, yes. 2. Concerns about event adjudication. Based on a report from Victor Serebruany, an adjunct faculty member at Johns Hopkins University, and the BMJ investigation, FDA records indicated that site reports documented 504 myocardial infarctions in patients who received ticagrelor compared to 548 in patients who received clopidogrel. However, after adjudication, the count increased only for the clopidogrel group, reaching 593. There was also some imbalance among groups in adjudicating death. These imbalances raise concerns about potential unblinding and result tampering. We read many of the authors' replies and we did not find a clear explanation of why all readjudicated extra MIs were in the clopidogrel group (45 clopidogrel; ticagrelor 0). 3. There were also concerns about the accuracy of death records as sites death records did not always match the FDA records.We cite from the BMJ: The BMJ's analysis also found omissions in PLATO's landmark publication. The paper, published in NEJM and reported as an intent-to-treat analysis, reports 905 total deaths from any cause among all randomized patients. An internal company report states, however, that 983 patients had died at this point. While 33 deaths occurred after the follow-up period, the NEJM tally still leaves out 45 deaths “discovered after withdrawal of consent.” The BMJ obtained some records for patients whose deaths were not reported in NEJM (see table 1) and asked the journal for a response.NEJM editor in chief Eric Rubin told The BMJ that “for older manuscripts, correction is not necessarily appropriate unless there would be an effect on clinical practice,” concluding that “it does not appear that correcting this 15-year-old article is going to have any impact.”It is noteworthy that the United States Department of Justice launched a formal investigation into the PLATO trial in 2013; however, the probe was closed in 2014. The BMJ column cited a spokesperson for the US attorney's office who said…”we determined that the allegations lacked sufficient merit such that it was not in the best interests of the US to intervene in the suit.” 4. Mortality reduction in PLATO defies explanation: Shortly after PLATO was published, Drs. Victor Serebruany and Dan Atar wrote an editorial in the European Heart Journal titled: The PLATO trial: do you believe in magic? They noted that the overall HR for all-cause death ticagrelor vs clopidogrel was 0.78 (95% CI: 0.69 - 0.89; p< 0.001). There were 107 more lives saved with ticagrelor vs clopidogrel. To explain the surprise of this massive effect size, they compared it to the COMMIT trial of clopidogrel vs placebo in patients with acute MI. In COMMIT, 119 lives were saved with clopidogrel (vs placebo), but COMMIT had three-fold more patients than PLATO—and the gain was vs placebo. They tempt the reader to ask: how could ticagrelor fare that well against a drug that crushed placebo? We note two other reasons to be concerned about the outsized mortality reduction in PLATO. One is plausibility. The all-cause mortality benefit exceeded the reduction in MI, CV death or stroke. Given the numerically higher rate of bleeding, how else does ticagrelor reduce death vs clopidogrel? The second reason is the lack of such a signal in Phase 2 studies, such as this one. 5. PLATO results are on outlier: Multiple observational studies have failed to replicate the benefits of ticagrelor observed in the PLATO trial. While observational studies are inherently limited by confounding factors and are inferior to randomized trials, their findings warrant a re-evaluation of ticagrelor's benefits. Furthermore, two randomized trials—one conducted predominantly in Japanese patients and another in South Korea—did not demonstrate the superiority of ticagrelor, instead showing higher bleeding rates and a numerical increase in ischemic events.Ticagrelor also significantly underperformed against another new antiplatelet drug, prasugrel. In the non-industry-funded ISAR-REACT 5 trial, which enrolled patients with acute coronary syndrome, the primary event of death, MI, or stroke was 36% higher in the ticagrelor arm (9.3% vs 6.9%, HR 1.36, 95% CI: 1.09 - 1.70). Major bleeding was also numerically higher in the ticagrelor arm. 6. PLATO authors have responded to these arguments.We provide links to four of the authors responses. * Thrombosis and Hemostasis https://www.wellesu.com/10.1160/TH11-03-0162* Stroke https://www.ahajournals.org/doi/10.1161/strokeaha.111.000514* Inter J of Cardiol https://doi.org/10.1016/j.ijcard.2014.06.029* Circulation https://doi.org/10.1161/CIRCULATIONAHA.111.047498Conclusion These are vitally important revelations regarding PLATO and ticagrelor. The FDA advisory committee recommended that FDA require a confirmatory trial. This was not done. As such, ticagrelor gained serious market share in the non-clopidogrel antiplatelet market for more than a decade. Yet no other compelling evidence for its benefit over clopidogrel has come to light. It clearly underperformed vs prasugrel. These old and new revelations have changed our positive view of ticagrelor. We no longer have confidence in this drug. We strongly agree with the recommendation for another properly controlled trial. We also believe this highlights the benefits of having either two regulatory trials or a single regulatory trial combined with a mandated post-approval trial. These revelations also emphasize the benefits of robust critical appraisal and skeptical but not cynical approaches to surprising evidence. Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Dr Tony Wan shares the results of a study that examined the effectiveness of an anticoagulation stewardship program (ACSP) in improving adherence to venous thromboembolism (VTE) prophylaxis guidelines and reducing costs at a Canadian teaching hospital. Here what he has to say about the results and the process of setting up the study in his hospital.Tony Wan, Stephanie J. Garland, Chipman Taylor Drury, Justin Lambert, Joshua Yoon, Melissa Chan, Anticoagulation stewardship: Improving adherence to clinical guidelines and reducing overuse of venous thromboembolism prophylaxis in hospitalized medical patients, Thrombosis Research, Volume 239, 2024, https://www.sciencedirect.com/science/article/pii/S0049384824001622 Donate to Thrombosis Canada: https://thrombosiscanada.ca/donateSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
Want to add a healthy habit to your daily routine that is absolutely free and incredibly effective? Looking to reduce insulin resistance and lose visceral fat? Want to boost mental health and improve cognitive function? Look no further than walking! Tune in to hear us unpack the myriad of research-supported benefits. In this episode, we discuss the incredible benefits of walking, from lowering blood pressure to improving heart rate variability to reducing stress and so much more. Learn about the magic number when it comes to step count, our thoughts on walking in nature vs. on a treadmill, and get practical tips for getting those steps! Also in this episode: Naturally Nourished Teas are buy 3 get 1 FREE, use code FREETEA Gift cards at Naturally Nourished Detox Masterclass 1/8 Keto Masterclass 1/15 Walking Pad C2 use code ALIMILLERRD for savings Health Benefits of Walking Lowers Blood Pressure Hypertension: Brisk walking for 30 minutes, five days a week reduces blood pressure (Hypertension, 2020). Improves Cholesterol Levels Cholesterol: Effects on LDL and HDL cholesterol (Journal of the American Heart Association, 2021). Lipid Profiles: Walking improves triglycerides and HDL (Atherosclerosis, 2021). Reduces the Risk of Coronary Artery Disease Coronary Artery Disease Risk: 150 minutes of walking weekly (Circulation, 2022). Enhances Cardiorespiratory Fitness Reduces Systemic Inflammation Systemic Inflammation: Walking lowers CRP and IL-6 (Arteriosclerosis, Thrombosis, and Vascular Biology, 2020). Systemic Inflammation: Walking reduces inflammatory cytokines (The Journal of Endocrinology, 2022). Helps Maintain Healthy Weight and Prevent Obesity Improves Heart Rate Variability Heart Rate Variability: HRV improvement with regular walking (Heart, 2022). Prevents Peripheral Artery Disease Peripheral Artery Disease: Walking improves circulation and function in PAD patients (Journal of Vascular Surgery, 2021). Reduces Resting Heart Rate Enhances Endothelial Function Supports Recovery After Cardiac Events Improves Insulin Sensitivity Insulin Sensitivity: Improvements with post-meal walks (Diabetes Care, 2021). Enhances Glucose Regulation Boosts Fat Oxidation Fat Oxidation: Brisk walking boosts fat metabolism (Journal of Applied Physiology, 2022). Reduces Visceral Fat Reduction of visceral fat after 10,000 steps/day (Obesity, 2021). Promotes Energy Balance Energy Balance: 12,000 steps/day for maintaining weight (Medicine & Science in Sports & Exercise, 2020). Regulates Hormones Related to Metabolism Increases Mitochondrial Efficiency Improves Metabolic Flexibility Prevents Metabolic Syndrome Helps Manage Type 2 Diabetes Mental health Stress Reduction: Nature walks lower cortisol more than treadmill (Environmental Research, 2022). Stimulates Neurogenesis and Brain Plasticity Brain Connectivity: Walking improves default mode network activity (Journal of Aging Research, 2021). Enhances Neurotransmitter Balance Supports Autonomic Nervous System Regulation Improves Sensory Integration Vestibular Function: Enhancing balance and stability with walking (Frontiers in Neuroscience, 2021). Strengthens Cognitive Function Neurogenesis and Cognitive Function: Exercise-induced brain growth (Nature Neuroscience, 2021). Promotes Myelination and Nerve Health Enhances Emotional Regulation via the Vagus Nerve Reduces Neurological Disease Risk Synchronizes the Nervous System Through Rhythmic Movement Improves Sleep and Circadian Rhythm Bone and Joint Health Immune System Support Longevity and Reduced Mortality Gut Health Gut Health: Positive effects on microbiota diversity (Gut Microbes, 2020). The Science of Step Counts Thoughts on Nature vs. Treadmill Walking Cognitive Benefits: Nature walking improves attention restoration (Nature Neuroscience, 2021). Proprioception: Benefits of uneven terrain in natural settings (Journal of Sports Medicine, 2023). Motivation: Outdoor walkers maintain habits better than treadmill users (Behavioral Medicine, 2022). Immune Boosting: Increased NK cell activity in forest walkers (International Journal of Environmental Health Research, 2021). Sponsors for this episode: According to extensive research by the Environmental Working Group, virtually every home in America has harmful contaminants in its tap water. That's why you've got to check out AquaTru. AquaTru purifiers use a 4-stage reverse osmosis purification process, and their countertop purifiers work with NO installation or plumbing. It removes 15x more contaminants than ordinary pitcher filters and are specifically designed to combat chemicals like PFAS in your water supply. Naturally Nourished Podcast listeners can use code ALIMILLERRD at AquaTru.com to save 20% off.
Commentary by Dr. Tzu-Fei Wang.
Welcome to Ask Stago, The Podcast dedicated to provide expert answers to your expert questions in coagulation. In today's episode, our guest Dr. Refaai will help us understand the formation and function of fibrin monomers (FM) in hemostasis, highlighting their crucial role in coagulation and clot formation and the need for more prospective studies to validate this assay for clinical indications such as DIC, VTE and cancer. Literature sources: Refaai M.A. (2018) The Clinical Significance of Fibrin Monomers. Thromb Haemost, 118, 1856. Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.
Stroke survivor Molly Buccola inspires others with her recovery from venous sinus thrombosis and her mission to bring connection and hope to others. The post Molly Buccola's Recovery from Venous Sinus Thrombosis: A Story of Resilience and Purpose appeared first on Recovery After Stroke.
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on flow dynamic factors correlated with device-related thrombosis after left atrial appendage occlusion.
Host: Darryl S. Chutka, M.D. [@chutkaMD] Guest: Atul Jain, M.D., M.S. Cardiovascular disease is the leading cause of death for both men and women and it's responsible for 1 in every 5 deaths. It's estimated to cost over $250 billion a year, which includes the cost of medical services, medications and lost productivity. Patients with cardiovascular disease are commonly seen in a general medical practice and since it's such a common health problem, we're all pretty comfortable managing these patients. But do we know what's happening pathologically? What's the role of cholesterol and inflammation in cardiovascular disease? What causes the inflammation? How do we measure it and most importantly, can we do anything about it? I'll be asking these questions of our guest, internist Atul Jain, M.D., M.S., from the Division of General Internal Medicine at the Mayo Clinic as we discuss the interplay between cholesterol, inflammation and thrombosis in cardiovascular disease. These talks on Inflammation and Cardiometabolic Disease are sponsored by Novo Nordisk Learn more about this series HERE Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.
Professor Erica Spatz MD talks to Dr Funmi Okunola MD about the effects of Long COVID on the heart. Professor Spatz is a cardiologist and clinical investigator at the Centre for Outcomes Research and Evaluation. She is the Associate Professor of Cardiology and Associate Professor of Epidemiology at Yale School of Medicine in the USA and is the Director of the Preventative Cardiovascular Health Program. REFERENCES1.Shah SM, Odanovic N, Kunnirickal S, Feher A, Pfau SE, Spatz ES. Chest pain and coronary endothelial dysfunction after recovery from COVID‐19: A case series. Clinical Case Reports. 2022 Apr;10(4):e05612.2.HilserJR, Spencer NJ, Afshari K, Gilliland FD, Hu H, Deb A, Lusis AJ, Wilson Tang WH, Hartiala JA, Hazen SL, Allayee H. COVID-19 Is a Coronary Artery Disease Risk Equivalent and Exhibits a Genetic Interaction With ABO Blood Type. Arteriosclerosis, Thrombosis, and Vascular Biology. 2024 Nov;44(11):2321-33.
Dupilimab received FDA approval as the first biologic treatment for adults with uncontrolled COPD, reducing exacerbations significantly in clinical trials. A study in JAMA Internal Medicine demonstrated that improper arm positioning during blood pressure measurements can lead to overestimated readings, potentially causing misdiagnosis. Another study in Atherosclerosis, Thrombosis, and Vascular Biology linked COVID-19 to long-term risks of major adverse cardiac events (MACE), with increased risks for patients hospitalized with COVID-19 and those with non-O blood types. These findings underscore the need for attention to proper clinical practices and long-term monitoring of cardiovascular health post-COVID-19.
In this podcast, various residency program directors and residents from across the state share some unique aspects of their PGY-2 ambulatory care residency experiences. Listen in to hear more about the following programs:Aurora Health Care Metro, Inc. PGY-2 Ambulatory Care Pharmacy Residency – Jennifer Foti, PharmD, BCACP (RPD)Froedtert & MCW PGY-2 Ambulatory Care Residency – Jonathan White, PharmD, BCACP (RPD)Froedtert & MCW PGY-2 Thrombosis and Hemostasis Management Residency – Mikie Te Ronde, PharmD (RPD) and Julia Kluck, PharmD (current PGY-2 resident)Mayo Clinic Health System – Eau Claire Hospital, Inc. PGY-2 Ambulatory Care Residency – Katie Taylor, PharmD, BCACP (RPD)SSM Health – Monroe Clinic PGY-2 Ambulatory Care Residency – Julie Bartell, PharmD, BCACP (RPD) and Kelly Thomas, PharmD (current PGY-2 resident)UW-Health PGY-2 Ambulatory Care Residency – Kristina Heimerl, PharmD, BCACP (RPD)
Astaxanthin is a red pigment produced by red algae that has many benefits for our bodies.Studies show Astaxanthin contributes to 12% longer lifespan for rats…Astaxanthin:It is a powerful Antioxidant that is 100 times stronger than Vitamin E and balances the oxidants with Antioxidants; both are needed in our bodies.Has anti inflammations properties…Even better, it goes into our cells and protects them.Astaxanthin increases our longevity gene FOXO3 to 90%… this means longer life with better cells.Increases our body workout performance, studies for all kinds of exhausting exercises.It reduces skin inflammations or redness of the skin and makes our skin better and more beautiful. The same is true for our eyes. It is taken and sold for skin and eye problems… Helps and heals our heart and Cardiovascular system, for instance, arteriosclerosis, Thrombosis, Fibroatheroma… It helps with Diabetes Type II.It renews the cells in our brains and makes us think better.It helps to protect our brains from Alzheimer's and dementia. Astaxanthin is fat soluble, so best taken with fatty food or with the meal, then, is the absorption into our cells better.Astaxanthin should be supplemented between 4mg and 12mg per day…Most of the Astaxanthin supplements are fake!Buy only Astaxanthin supplements from well-known brands like Double Sword or Now! Both brands sell the highest quality of Astaxanthin and even more than labeled in the packages. From 19 Astaxanthin supplements sold on Amazon, 15 Astaxanthin supplements are without any Astaxanthin or less than 1mg of Astaxanthin. People above the age of 60 years should supplement it every day.Negative side effects More bloating in the guts and reddish excrements …… And well used from My Video: Astaxanthin contributes to a 12% longer lifespan… https://youtu.be/pU4lz0p-A7cMy Audio: https://divinesuccess.net/wp-content/uploads/2021/Podcast4/Astaxanthin-contributes-to-a-12-longer-lifespan.mp3
In this episode, Miguel and Lucas dive into the details of an intriguing case involving a patient with a lower extremity ischemia, possibly exacerbated by a prior COVID infection and cardiovascular risks. The conversation covers the challenges and nuances of managing stenosis and plaque buildup in peripheral arteries, with an emphasis on using cutting-edge techniques such as atherectomy and drug-coated balloons. Key Discussion Points: Patient Case Overview: The patient, a relatively healthy golfer with a history of prothrombotic events post-COVID, faced intermittent claudication and severe stenosis. The team walks through the case's progression and their decision-making process. Medical Optimization Challenges: The hosts highlight the common issue of failed conservative treatments like medication and exercise programs. Miguel discusses the frustrations patients face when optimization fails, leading to pressure on surgeons for more aggressive interventions. Endovascular Techniques Explored: Imaging Insights: The importance of ultrasound and IVUS (Intravascular Ultrasound) in guiding procedural decisions is emphasized, especially in identifying the type of plaque (soft vs. calcified) and the need for debulking. Atherectomy vs. Laser vs. Drug-Coated Balloon: Miguel shares his preference for the RotorX atherectomy device over other methods like laser, citing its versatility in treating soft plaque, clot, and stenosis. Lucas offers his perspective on alternative approaches. Case Reflection: The episode's dramatic twist occurs when a previously undetected lesion surfaces, prompting a reassessment of the procedure and further interventions. Patient Outcome: After a successful intervention with the RotorX device and a drug-coated balloon, the patient returned to golfing, demonstrating the real-world impact of these complex procedures. Humor & Hot Takes: Throughout the episode, Miguel and Lucas share lighthearted moments, including "dad jokes" and banter about their experiences in the medical field, making this technical conversation engaging for both seasoned professionals and learners. Key Takeaways: The importance of thorough imaging in vascular procedures. Why atherectomy devices, when used correctly, can be game-changers in treating challenging cases. How to balance conservative management with more aggressive interventions when dealing with peripheral artery disease.
Listen as Dr. London Smith (.com) and his producer Cameron discuss Renal Vein Thrombosis with special guest Dawn (Kristen Gully). Not so boring! https://www.patreon.com/join/jockdocpodcast Hosts: London Smith, Cameron Clark. Guest: Kristen Gully. Produced by: Dylan Walker Created by: London Smith
N-acetyl cysteine (NAC) shows promise for heart attack preventionHeart attacks and strokes are a leading cause of death in developed countries - accounting for ~20% of all deaths in the U.S. Frequently, heart attacks and strokes are caused by blood clots (blood platelets that form when they are not needed, causing a narrowing/blockage of blood vessels) formed through arterial thrombosis. Current antiplatelet agents (e.g., aspirin) are effective but can increase major bleeding risk. As such, there is a growing need to prevent arterial thrombosis different from antiplatelet agents.A recent study published in Arteriosclerosis, Thrombosis, and Vascular Biology investigated the potential of NAC as an agent to prevent arterial thrombosis. Utilizing both [cell-based] human blood models and mouse (in vitro) models, the research demonstrated that NAC significantly delayed and even prevented thrombus formation dose-dependently without increasing bleeding risks.Findings:*NAC treatment extended clot formation times by up to 3.7 times compared to controls in the human blood [cell] model.*NAC entirely inhibited platelet aggregation and occlusive clot formation at higher doses than the above point in the cell model.*A 400 mg/kg (via injection in rodents) dose of NAC in mice effectively prevented arterial occlusion post-injury.*Lower doses (200 mg/kg - via injection in rodents) of NAC reduced clot stability, suggesting working as both an acute and preventative clotting therapy.The study showed that NAC interferes with von Willebrand factor (a large protein crucial for blood clotting) activity. NAC acts against VWF rather than platelets to prevent clot formation. Thus, providing a safer alternative to traditional antiplatelet drugs that carry higher bleeding risks. Support the Show.
Focus Issue on Thrombosis and Antithrombotic Treatment, Heart failure and Cardiomyopathies
Dr. Valentin Fuster discusses the treatment and diagnosis of transcatheter aortic valve thrombosis, focusing on its manifestations, diagnostic techniques using multi-slice computed tomography, and a proposed treatment algorithm. It highlights the difference between subclinical and clinical thrombosis and provides a detailed approach to managing both, including antiplatelet and anticoagulant therapies.
This week's VJHemOnc podcast brings you updates in hemophilia from the 32nd Congress of the International Society on Thrombosis and... The post Hemophilia updates from ISTH 2024: ongoing clinical trials, emerging gene therapies & remaining challenges appeared first on VJHemOnc.
Dr Deborah Siegal joins us for a discussion on the recent paper, The Efficacy and Safety of Andexanet Alfa in Patients With Acute Gastrointestinal Bleeding While Taking Factor Xa Inhibitors: An ANNEXA-4 Sub-analysis. In this wide-ranging discussion she reviews the results of the sub-analysis and the need for anticoagulant reversal for acute GI bleeding. This discussion provides her perspective on the issue of bleeding with DOACs and the challenges in patient management.Dr. Deborah Siegal MD MSc FRCPC is a clinician-scientist hematologist (thrombosis medicine) at The Ottawa Hospital, Associate Professor of Medicine and School of Epidemiology and Public Health at the University of Ottawa, and Scientist at the Ottawa Hospital Research Institute. Her primary research interest is improving the safety of anticoagulant therapy including optimizing the management of anticoagulant-related bleeding complications, restarting anticoagulants after bleeding, perioperative management of anticoagulants, and antithrombotic therapies for ischemic stroke in patients with cancer. Dr Siegal is a member of the board of directors of Thrombosis Canada. Reference:Siegal DM, Forbes N, Eikelboom J, Beyer-Westendorf J, Cohen AT, Xu L, Connolly SJ, Crowther M. The Efficacy and Safety of Andexanet Alfa in Patients With Acute Gastrointestinal Bleeding While Taking Factor Xa Inhibitors: An ANNEXA-4 Subanalysis. Circulation. 2024 Apr 16;149(16):1315-8.https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.123.066933Follow us on Twitter:@ThrombosisCan@debsiegalSupport the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
In this episode, we review the high-yield topic of Acute Subclavian Artery Thrombosis from the Hand section. Follow Orthobullets on Social Media: Facebook Instagram Twitter LinkedIn YouTube
Thomas Diacovo, MD, is chief of the UPMC Newborn Medicine Program and director of Neonatal Cardiovascular Research at the Heart Institute. Dr. Diacovo discusses how he became interested in Thrombosis research, his journey to Pittsburgh, and his research testing new drugs for neonatal intensive care patients, particularly those with congenital heart disease who are at high risk for forming blood clots. Dr. Diacovo also credits the parents of our patients for the success of his clinical trials.
Focus Issue on Thrombosis and Antithrombotic Treatment, Ischaemic Heart Disease, Dyslipidaemias
In this week's episode we'll learn about the clinical benefit of complete remission with partial hematological recovery, or CRh, in patients with Acute Myeloid Leukemia (AML) treated with molecularly targeted drugs. Then we'll hear about a large cohort of patients with PNH were studied to detail PNH-related thrombotic events, unravel determinants of thrombosis, and evaluate anti-coagulation strategies. Finally, we'll see how new research shows that SOX11 expression is restricted to EBV-negative Burkitt lymphoma, and is associated with a specific genetic landscape. Featured Articles:Complete Remission with Partial Hematological Recovery as a Palliative Endpoint for Treatment of Acute Myeloid Leukemia Paroxysmal nocturnal hemoglobinuria-related thrombosis in the era of novel therapies: a 2043 patient/years analysis SOX11 expression is restricted to EBV-negative Burkitt lymphoma and associates with molecular genetic features
In this week's episode we'll discuss the safety and efficacy of nilotinib with or without cytarabine in Philadelphia-positive acute lymphoblastic leukemia; learn more about thrombosis risk in double heterozygous carriers of Factor V Leiden and prothrombin G20210A and discuss the utility of circulating cell-free tumor DNA in prognostic prediction in patients with relapsed/refractory multiple myeloma.Featured Articles:Nilotinib with or without cytarabine for Philadelphia positive acute lymphoblastic leukemia Thrombosis risk in double heterozygous carriers of Factor V Leiden and Prothrombin G20210A in FinnGen and the UK Biobank ctDNA improves prognostic prediction in relapsed/refractory multiple myeloma receiving ixazomib, lenalidomide, and dexamethasone
In this week's episode we'll discuss the effects of voxelotor on cerebral blood flow in pediatric sickle cell disease, learn more about venous and arterial thrombosis in patients with Vexas syndrome, and discuss differential sensitivity to tyrosine kinase inhibitors in ABL-class acute lymphoblastic leukemia. Featured Articles:The influence of voxelotor on cerebral blood flow and oxygen extraction in pediatric sickle cell disease Venous and arterial thrombosis in patients with VEXAS syndrome Tyrosine kinase inhibitor response of ABL-class acute lymphoblastic leukemia: The role of kinase type and SH3 domain
Focus Issue on Thrombosis and Antithrombotic TreatmentYour voice matters. Take the EHJ Podcast survey.
//The Wire//2100Z May 8, 2024////ROUTINE////BLUF: ASTRAZENECA PULLS COVID VACCINE FROM MARKET.// -----BEGIN TEARLINE------International Events-Europe: The AstraZeneca COVID vaccine Covishield has been withdrawn from worldwide production. AstraZeneca claims that this drug was pulled from the market due to declining demand and a wide surplus of similar products from other brands.-HomeFront-USA: Pro-Palestine demonstrations continue at a variety of universities around the United States. Over the weekend, graduation ceremonies were disrupted at many universities as demonstrators begin to solidify what has so far been a less-than-coherent collection of positions/causes related to the pro-Palestine movement. AC: Lately, demonstrations in some cities have shifted to demanding universities divest from financial investment in (or any cooperation with) Israel as a condition for ceasing demonstrations. These efforts are unlikely to achieve the desired result, as 38 states have enacted anti-BDS laws specifically outlawing divestment from the state of Israel only. Consequently demonstrations, disruptions, and general unrest are likely to continue as the various controlling interests (from all participating factions) continue to entrench in varying ideological positions, and dig in for the long-haul this protest season.-----END TEARLINE-----Analyst Comments: AstraZeneca claims there is no link whatsoever to their drug being pulled from the market a few days after multiple international health groups (and AstraZeneca themselves) have admitted that a major side-effect of this vaccine is Thrombosis with Thrombocytopenia Syndrome (TTS), which results in “severe blood clotting events”. Before being pulled from the market, this vaccine was administered in over 150 nations.Analyst: S2A1//END REPORT//
This is the Catch Up on 3 Things for the Indian Express and I'm Flora Swain.It's the 3rd of May and here are the top stories of the week.Union Home Minister Amit Shah at a rally in UP's Bareilly attacked Rahul Gandhi, saying he started his party's campaign with Bharat Jodo Yatra that will end with a ‘Congress Dhoondho Yatra,' suggesting that the party will get a severe drubbing in the Lok Sabha elections. Addressing a rally in Gujarat, Prime Minister Narendra Modi launched a new attack on Congress saying “it is a mureed (follower) of Pakistan.” In Shivamogga, Rahul Gandhi raked up the many allegations of sexual abuse against Prajwal Revanna and said, “PM Modi has asked for votes for a ‘mass rapist'.”Meanwhile, the Ministry of External Affairs confirmed on Thursday that Janata Dal (Secular) leader Prajwal Revanna, who is at the centre of a sexual abuse case, travelled to Germany on a diplomatic passport and no political clearance was either sought from or issued by the MEA with respect to his travel to the country. Meanwhile, the SIT probing the allegations of sexual abuse against Prajwal has issued a lookout circular after he failed to appear before it officials following a notice of appearance served on Tuesday.After around 100 schools across Delhi-NCR received hoax bomb threats by email on Wednesday, the Delhi government's Directorate of Education (DoE) has issued an advisory asking schools to ensure timely checking of emails received on their official email ID. It added that “if anything unwanted is noticed,” the deputy director of education in the district or zone and the Delhi Police are to be informed immediately.Global pharmaceutical manufacturer AstraZeneca has admitted that its Covid-19 vaccine, developed by researchers from the Oxford University, can cause a rare side effect of blood clotting and low platelet count after immunisation. In India, the same vaccine, called Covishield and manufactured by the Pune-based Serum Institute, has been administered through 175 crore doses. Reportedly, the company made this admission of a side effect, Thrombosis with Thrombocytopenia Syndrome (TTS), in court as it faces a lawsuit alleging severe harm and deaths caused by the vaccine.Breaking days of silence as police crack down on campus protests over the war in Gaza, US President Joe Biden on Thursday said “destroying property and threatening people was not a peaceful protest” and asserted that it was “against the law.” In his first remarks on the ongoing student protests over the war in Gaza, Biden said the protests have put to the test the right to speech and the rule of law, adding that both must be upheld. “American people must have the right to be heard, but rule of law must be upheld,” he said in an address at the White House.This was the Catch-Up on the 3 Things by The Indian Express.
In this week's episode we'll discuss the mechanism by which Jak2V617F clonal hematopoiesis promotes arterial thrombosis, discuss how Staphylococcus aureus induces drug resistance in cancer T cells in Sézary syndrome, and learn more about the clinical and functional features of RAC2-related immunodeficiency.Featured Articles:Jak2V617F clonal hematopoiesis promotes arterial thrombosis via platelet activation and cross talkStaphylococcus aureus induces drug resistance in cancer T cells in Sézary syndromeClinical and functional spectrum of RAC2-related immunodeficiency
The world of association management is evolving, and Thomas Reiser, the executive director of the International Society on Thrombosis and Hemostasis, is at the forefront of this. Reiser sat down with Skift Meetings to share his insights on what is shaping the future of associations and events in a post-Covid-pandemic landscape. "The traditional membership value is diminishing," Reiser candidly reveals, pointing to the challenges facing associations worldwide. This captures the seismic shifts that have prompted organizations like ISTH to reassess and retool their value propositions to members. This episode covers: Reiser's varied and international career spans multiple association management roles, including his current role. He has implemented major shifts, including shifting from a biennial to an annual congress and insourcing almost all event-related roles. We discuss the importance of the real role of medical societies, which is ultimately to improve people's lives We delve into the importance of public-facing initiatives such as World Kidney Day and World Thrombosis Day, both of which Tom was involved in launching. How Tom and ISTH work with suppliers as consultants and true partners And finally we look at the key trends that Tom sees as the biggest challenges and opportunities. Head to www.skiftmeetings.com to explore our daily news coverage and free-to-access reports and events.
Jess and Alice talk a lot about bodies discovered in water and even more about private autopsies. Episode information- Rosewood S1 Ep18 Thorax, Thrombosis, and Threesomes Instagram: @insidethemorguepod Patreon: patreon.com/insidethemorgue Email: insidethemorguepod@gmail.com If you enjoy this podcast, support us! Music used from Pixabay.com: Crime Trap by Muzaproduction & Detective by SergeQuadrado Sources: https://murderpedia.org/female.T/t/trujillo-ana.htm https://abc13.com/stiletto-killer-texas-true-crime-man-killed-with-high-heeled-shoe-stefan-andersson-ana-trujillo-stabbed-to-death-by-heels/13832183/ https://www.texasmonthly.com/the-culture/high-heel-homicide/ --- Support this podcast: https://podcasters.spotify.com/pod/show/insidethemorgue/support
TWiM reveals a database of genome sequences of thousands of Mycobaterium tuberculosis, allowing association with resistance phenotypes to 13 antibiotics, and microbe-derived uremic solutes that enhance thrombosis potential in the host. Hosts: Vincent Racaniello, Michael Schmidt, and Michele Swanson. Become a patron of TWiM. Links for this episode M. tuberculosis genomes and antimicrobial resistance (PLoS Biol) The CRyPTIC consortium BashTheBug Zooniverse Microbial solutes enhance thrombosis (mBio) Can our microbiome break our heart? (mBio) Pathogenesis of cardiovascular disease (EJIFCC) How Kidneys Work Video (Mayo Clinic) What is a metaorganism? (Zoology) Take the TWiM Listener survey! Send your microbiology questions and comments (email or recorded audio) to twim@microbe.tv
Why were some people hit harder by mRNA COVID vaccines than others? Which seven core nutrients—in combination—work to revive cellular health after COVID vaccine injury? Over half a billion mRNA COVID vaccines have been dispensed in the United States. Many people have suffered severe side effects to these vaccines, including thrombosis, stroke, and myocarditis. But what biochemical factors account for those suffering minimal or no side effects? Amid spike-protein toxicity, the greater resilience shown by some people comes down to the health and function of three main cellular systems—whose functions range from cellular energy production to enabling nerve-to-nerve communications, says neuroscientist and biochemical researcher Dr. Dayan Goodenowe. Dr. Goodenowe's targeted nutrient treatment aims to replenish these key systems. For Vital Signs COVID-Vax Rescue PART 3, host Brendon Fallon explores the results of this treatment on several patients, including two who suffered major health crises following vaccination. From n-acetylcysteine to support cellular energy production to phospholipid plasmalogens to shore up nerve-cell membranes, Dr. Goodenowe details the seven core nutrients to revive cell health after mRNA vaccine injury. Over several decades, Dr. Goodenowe has developed systems for diagnosis, prevention, and treatment across a range of diseases—including autism, amyotrophic lateral sclerosis (ALS), and Alzheimer's disease—as covered previously on Vital Signs with Brendon Fallon. ⭕️ Watch in-depth videos based on Truth & Tradition at Epoch TV
On this episode of Week In Review The FARM clinicians discuss a complex case involving cerebral venous sinus thrombosis and the roadblocks that stood in the way of an easy diagnosis, how losing sight of truly treating function can prolong treatment and reduce effective outcomes, and how treating something like chondromalacia patella should be less about the diagnostic moniker and more about the individual case presentation. --- Send in a voice message: https://podcasters.spotify.com/pod/show/thefarmcast/message
The Vasopressor & Inotrope Handbook: Amazon Affiliate Link (I will earn an extra small commission) and Signed Copies. Show Notes: eddyjoemd.com/asymptomatic-catheter-related-thrombosis/ Explore the often-overlooked issue of asymptomatic catheter-related thrombosis (CRT) in ICU patients on The Saving Lives Podcast. This episode delves into a revealing study published in the Annals of Intensive Care, uncovering the incidence, risk factors, and implications of asymptomatic CRT. Join us for a thought-provoking discussion that challenges traditional beliefs and sheds light on crucial aspects of catheter management in critical care. TrueLearn Link: https://truelearn.referralrock.com/l/EDDYJOEMD25/ Discount code: EDDYJOEMD25 This Podcast was edited using Descript: https://www.descript.com?lmref=BGOxjQ Citation: Abbruzzese C, Guzzardella A, Consonni D, Turconi G, Bonetti C, Brioni M, Panigada M, Grasselli G. Incidence of asymptomatic catheter-related thrombosis in intensive care unit patients: a prospective cohort study. Ann Intensive Care. 2023 Oct 19;13(1):106. doi: 10.1186/s13613-023-01206-w. PMID: 37858003; PMCID: PMC10587047. Link to Article --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support
Maddie's 7 Cardinal Movements of a Successful Delivery: 1. Head comes out 2. Head turns 3. Cord Assessment 4. Anterior shoulder delivered 5. Posterior shoulder delivered 6. Body delivered. 7. Baby on mom's chest T's of Postpartum Hemorrhage: 1. Tone 2. Trauma 3. Tissue 4. Thrombosis