Podcasts about VTE

Episode OverviewFor the second time in two decades, a phase 3 trial has shown a statistically significant improvement over R-CHOP in newly diagnosed diffuse large B-cell lymphoma (DLBCL). In this episode, Eddie, Raj, and Ashwin sit down with Professor Charles Herbaux to unpack the data, debate the clinical implications, and ask the question that's on every hematologist's mind: is this enough to change practice?Background: Setting the Stage for TafasitamabBefore diving into frontMIND, the episode provides context on tafasitamab, a CD19-targeting monoclonal antibodyL-MIND (Phase 2 — relapsed/refractory DLBCL):81 patients with R/R DLBCLORR 58%, complete response rate 41%Established activity of tafasitamab + lenalidomide in the relapsed settinghttps://pubmed.ncbi.nlm.nih.gov/32511983/First-MIND (Phase 1b — frontline DLBCL, IPI 2–5):66 patients randomized: tafa-R-CHOP (n=33) vs. tafa-len-R-CHOP (n=33)ORR: 75.8% vs. 81.8%, respectivelySerious treatment-emergent adverse events: 42.4% vs. 51.5%Provided the signal (and the safety caution) to move to phase 3https://pubmed.ncbi.nlm.nih.gov/37369099/The frontMIND TrialDesign: Phase 3, double-blind, placebo-controlled randomized trialIntervention: R-CHOP + tafasitamab (12 mg/kg IV days 1, 8, 15 per cycle) + lenalidomide (25 mg/day, days 1–10 per cycle)Control: R-CHOP + placebosGCSF mandatory (given double-blind design); VTE prophylaxis (heparin or aspirin) mandatory given lenalidomideEnrollment: May 2021 – March 2023; 899 patients randomizedPrimary endpoint: Investigator-assessed progression-free survival (PFS)Patient Population:Age 18–80; DLBCL or high-grade B-cell lymphoma, IPI 3–5Median age: 65 years96% advanced stage; 54% bulky disease; 31% ECOG PS 2; 82% elevated LDH55% IPI 3 / aaIPI 2; 43% IPI 4–5 / aaIPI 38% double/triple hit — a high-risk subgroup included despite R-CHOP being the controlBroad histologic inclusion: transformed lymphoma, grade 3B FL, T-cell/histiocyte-rich LBCL, EBV+ DLBCL, ALK+ LBCL, HHV8+ DLBCL Note: On retrospective central review, ~7% of patients had a different histology (roughly half had FL grade 1–3A), underscoring the diagnostic challenges in DLBCL~40% received pre-phase steroids; 8% rituximab; 4% vincristine prior to cycle 1Key Efficacy Results(Primary analysis at median follow-up 35.2 months) | Endpoint | Tafa-Len-R-CHOP | R-CHOP | HR / p-value | 2-year PFS | 71.1% | 62.9% | HR 0.75, p=0.0194 | 3-year PFS | 67.3% | 60.7% | ~6.6% absolute difference | Overall Survival | — | — | HR 0.85, p=0.27 (immature)Points of Discussion:Absolute PFS benefit at 2 years: ~8.2%; at 3 years: ~6.6% — a modest but statistically significant improvementOS curves cross early, then separate slightly from ~18 months; data remain immatureEarly censoring observed: ~17% (intervention) and ~14% (control) censored by 9 months — raises questions about off-protocol therapySubgroup consistency: PFS benefit appeared consistent across prespecified subgroups; specific subgroups discussed in the episodeSafety Adverse Event | Tafa-Len-R-CHOP | R-CHOP | Fatal treatment-emergent AEs | 6% (26 pts) | 4% (17 pts) | Diarrhea (any grade) | 25% | 17% | Febrile neutropenia | 17% (incl. 1 death) | 13% | Grade ≥3 anemia | 24% | 17% | Grade ≥3 thrombocytopenia | 27% | 14%The addition of tafasitamab and lenalidomide to R-CHOP adds meaningful hematologic toxicity, particularly thrombocytopenia and anemia, as well as diarrhea and febrile neutropenia.Key Discussion Points from the EpisodeDid the early-phase L-MIND and First-MIND data justify bringing tafasitamab into the front-line setting, and was tafa-len-R-CHOP the right intervention arm to take forward?Is R-CHOP the appropriate control for a patient population that includes 8% double/triple hit lymphoma?What are the implications of using investigator-assessed PFS as the primary endpoint — and how critical is effective blinding to the integrity of that endpoint?How do we interpret the early OS curve crossing and currently non-significant OS benefit?Is the ~8% absolute PFS improvement at 2 years clinically meaningful enough to change practice — particularly given the added toxicity?How should we think about patient selection: who would you prioritize for tafa-len-R-CHOP over standard R-CHOP in clinical practice?What does frontMIND mean for the DLBCL treatment landscape alongside polatuzumab-R-CHP (POLARIX)?Resources & Further ReadingfrontMIND trial: Lenz et al. Lancet. https://pubmed.ncbi.nlm.nih.gov/42217458/POLARIX: Tilly H, et al. NEJM 2022About BloodCancerTalksBloodCancerTalks is a medical education podcast hosted by Raj, Ashwin, and Eddie, dedicated to the latest advances in hematologic malignancies. New episodes available wherever you listen to podcasts.Follow us on X/Twitter for episode updates and hematology/oncology content. 

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

This podcast by Dr. Larissa Araújo de Lucena discusses the development of the ONCO‑DOAC BLEED score for predicting major bleeding in patients with cancer‑associated venous thromboembolism (VTE) receiving direct oral anticoagulants. The findings support a more personalized, risk‑based approach to anticoagulation in cardio‑oncology, integrating cancer type, comorbidities, and clinical factors while highlighting the need for broader validation.

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that's great for Family medicine or internal medicine, but how does that affect us in women's health? Well, it's complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

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

Malignant Bowel Obstruction, VTE and Goals of CareMaster malignant bowel obstruction, cancer-associated thrombosis, and goals-of-care conversations in hospitalized patients with advanced cancer. Learn practical approaches to symptom management, anticoagulation decisions, and navigating high-stakes discussions around prognosis and hospice care. We're joined by  Dr. Jensa Morris, @JensaMorrisMD (Yale School of Medicine).Claim free CME for this episode at curbsiders.vcuhealth.org!Show Segments Intro Picks of the Week Case 1: Malignant small bowel obstruction: definitions, initial management, medications, NG tubes, nutrition, and procedural options Case 2: Cancer-associated VTE: choice of anticoagulant, treatment duration, unusual thromboses, and anticoagulation with brain metastases  Case 3: Goals of care: prognosis, performance status, palliative care, hospice and end-of-life planningTake Home Points Outro  Credits Writer, producer, and show notes: Reaford Blackburn, Jr., MD Infographic, Cover Art: Caroline Coleman, MD Hosts: Monee Amin, MD and Meredith Trubitt, MD    Reviewer: Rahul Ganatra, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Jensa Morris, MD Sponsor: Continuing Education CompanyVisit CMEmeeting.org/curbsiders and use promo code Curb30 for 30% off all online courses and webcasts.  Sponsor: LocumstoryLocumstory.com is literally just a free, unbiased resource dedicated to educating physicians about locums.Sponsor: Mint MobileTo get your new wireless plan for just 15 bucks a month, go to mintmobile.com/CURB. 

TopMedTalk introduces our new "TopMedTalk Classics" series with a classic TopMedTalk episode from 2018 that is still prescient today. This lecture, given by Sir Bruce Keogh marked the NHS's 70th birthday, a time framed by political volatility, financial constraint, rising demand, and shifting public expectations. Keogh argues healthcare systems must adapt, highlighting the UK's strengths in medical science, innovation, life sciences, and the scale and complexity of the NHS. He describes quality improvement efforts since 2008, including defining quality as effectiveness, safety, and patient experience, developing outcomes measures, and using aligned clinical and managerial leadership to drive change. Examples include major reductions in MRSA, rapid increases in VTE assessment, improved survival from major trauma networks, better hip-fracture care, strong heart-attack and sepsis performance, stroke centralization benefits, and increased dementia diagnosis for support. He emphasizes future pressures from ageing, prevention, the health–social care split, Brexit workforce and drug costs, and emerging forces like mobile tech, AI, genomics, and gene therapy, arguing the NHS's pooled, universal model is well suited to a genomics-enabled future. -- Join us at Evidence Based Perioperative Medicine (EBPOM) World Congress 2026 in London. Be part of a global conversation as clinicians from around the world gather between 7-9th July at the British Library in London. Three days of evidence-based perioperative medicine, global insights, and expert debate—featuring speakers including Michael Marmot and Ken Rockwood. Register here - https://ebpom.org/product/ebpom-world-congress-2026/ 00:00 TopMed Talk Intro 00:18 Classics Episode Setup 01:31 Introducing Sir Bruce 02:23 Politics And Adaptation 04:41 Global Pressures On Healthcare 05:48 Hard Times Build NHS 07:35 UK Innovation Advantage 10:33 NHS Scale And Complexity 12:27 Darzi Review Quality Drive 16:10 Outcomes Framework Explained 17:20 Safety And High Level Metrics 18:09 MRSA Turnaround Lesson 20:11 Mandating VTE Prevention 22:58 Trauma Networks Results 24:08 Hip Fracture Best Practice 25:21 Heart Attack Care Wins 26:17 Sepsis And Early Warning 28:01 Stroke Centralization Success 28:45 Dementia Targets Debate 30:31 Leadership And Brexit Risks 32:35 Health And Social Care Split 36:01 Tech Disruption Ahead 36:49 Genomics And NHS Values 38:00 Closing And Congress Promo

Joe Kiani is Executive Chairman at Willow Laboratories and Founder of the Patient Safety Movement Foundation.   He makes the point that the vast majority of medical harm is avoidable through the implementation of evidence-based healthcare best practices. Technology, particularly AI and remote monitoring of data from medical devices, is crucial for creating predictive models that can alert clinicians to problems and identify root causes of medical errors. The goal is to unite all healthcare stakeholders to work collaboratively toward zero preventable deaths. Joe explains, "In the US, we lose about 200,000 people a year, and about 15 times that rate is the serious harm caused by medical errors. Worldwide, we think the number is close to three million. And the reason we call it preventable is that the vast majority could be eliminated if evidence-based practices were put in place. As you can imagine, people make mistakes, and there are a lot of medical errors that may not be preventable because there is an evidence-based practice in place to avoid them. But when it comes to things like hospital-acquired infection, VTE, sepsis, failure to rescue, CLATSI, there are known evidence-based practices that, if possible, put them in place, we might get to zero, and if not zero, we'd be pretty close to zero." "Well, honestly, all patients are at risk. If you want to focus on those most at risk, we've got to miss the ones that really go wrong. If we can imagine someone going in for a simple procedure, even a cosmetic one, like a hip replacement, and the procedure goes really well." "But while there's a catheter inside the artery, someone could walk in and, without cleaning their hands, touch the patient, the bacteria could enter the bloodstream and cause a serious infection. So really, you've got to create a culture of safety where you look for ways to mitigate people's mistakes, and those are what we call evidence-based practices. There are about 20 of them, starting with cultural patient safety, on the Patient Safety Movement Foundation website that people can freely download and implement, and therefore not get into these problems." #PatientSafetyMovementFoundation #PatientSafetyMovement #PatientSafety #HealthcareQuality #ZeroHarm #EvidenceBasedPractice #AIinHealthcare #ClinicalSafety #HospitalLeadership #MedTech #CultureOfSafety #PreventableHarm #FailureToRescue #Sepsis #VTE #PatientExperience #ClinicianBurnout willowlabs.ai psmf.org Download the transcript here

Joe Kiani is Executive Chairman at Willow Laboratories and Founder of the Patient Safety Movement Foundation.   He makes the point that the vast majority of medical harm is avoidable through the implementation of evidence-based healthcare best practices. Technology, particularly AI and remote monitoring of data from medical devices, is crucial for creating predictive models that can alert clinicians to problems and identify root causes of medical errors. The goal is to unite all healthcare stakeholders to work collaboratively toward zero preventable deaths. Joe explains, "In the US, we lose about 200,000 people a year, and about 15 times that rate is the serious harm caused by medical errors. Worldwide, we think the number is close to three million. And the reason we call it preventable is that the vast majority could be eliminated if evidence-based practices were put in place. As you can imagine, people make mistakes, and there are a lot of medical errors that may not be preventable because there is an evidence-based practice in place to avoid them. But when it comes to things like hospital-acquired infection, VTE, sepsis, failure to rescue, CLATSI, there are known evidence-based practices that, if possible, put them in place, we might get to zero, and if not zero, we'd be pretty close to zero." "Well, honestly, all patients are at risk. If you want to focus on those most at risk, we've got to miss the ones that really go wrong. If we can imagine someone going in for a simple procedure, even a cosmetic one, like a hip replacement, and the procedure goes really well." "But while there's a catheter inside the artery, someone could walk in and, without cleaning their hands, touch the patient, the bacteria could enter the bloodstream and cause a serious infection. So really, you've got to create a culture of safety where you look for ways to mitigate people's mistakes, and those are what we call evidence-based practices. There are about 20 of them, starting with cultural patient safety, on the Patient Safety Movement Foundation website that people can freely download and implement, and therefore not get into these problems." #PatientSafetyMovementFoundation #PatientSafetyMovement #PatientSafety #HealthcareQuality #ZeroHarm #EvidenceBasedPractice #AIinHealthcare #ClinicalSafety #HospitalLeadership #MedTech #CultureOfSafety #PreventableHarm #FailureToRescue #Sepsis #VTE #PatientExperience #ClinicianBurnout willowlabs.ai psmf.org Listen to the podcast here

Join primary care faculty Gary Ferenchick, Kate Rowland, Henry Barry and Mark Ebell as they discuss 4 important new studies: the value (?) Of biomarkers in cognitive impairment, toilet training, bleeding risk with apixaban versus rivaroxaban for VTE, and diagnosing volume overload in adults  from the JAMA Rational Clinical Exam series.

Join us as we review recent practice-changing articles on left atrial appendage closure vs AC for AFib, apixaban vs rivaroxaban for VTE, intensive LDL targeting, GLP1s and substance use disorders, and more! Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Shani Herzig (@ShaniHerzig) Rahul Ganatra (@rbganatra), and Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Rahul Ganatra MD, MPH; Shani Herzig, MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Rahul Ganatra MD, MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Left atrial appendage closure vs anticoagulation in AF Apixaban vs rivaroxaban for VTE Intensive LDL targeting in ASCVD GLP1s and substance use disorders FDA approves Orforglipron E-cigarettes and cancer Early AM blood draws and sleep quality Outro Sponsor: FIGSGo to wearfigs.com to get 20% off during Nurses WeekSponsor: Panacea Financial If you're about to make the leap into  residency and feeling the financial pressure of that transition, visit PanaceaFinancial.com/curbsiders todaySponsor: MasterClass Right now, as a listener of this show, you get at least 15% off any annual membership at MASTERCLASS.com/CURB.

Hay historias que no se agotan en las canciones.Algunas siguen creciendo en quienes las escuchan, las recuerdan y las vuelven a contar.En este episodio de RASCACIELOS, nos metemos en ese territorio junto a Allan Kelly Márquez, autor de Sodamanía. Un recorrido por el pulso de Soda Stereo desde un lugar distinto: el de los fans, la memoria colectiva y todo lo que se construyó alrededor de la banda.Un episodio para volver a mirar una historia conocida… desde otro ángulo.Si te interesa este tipo de contenidos, podés encontrarnos también en YouTube.Suscribite y ayudanos a seguir creciendo.Y si querés sumar pisos a este Rascacielos... Podés invitarnos un cafecito.https://cafecito.app/rascacielospodcast☕️Producción integral: Matías Ponfil Conducción: @gonzalosiddig / @matiasponfiloficialLa locución artística es un lujo que nos damos. Gracias al enorme @perrozavatti!Diseño y edición audiovisual: @matiasponfiloficial Música original: @matiasponfiloficialEste episodio fue grabado en TUNEL 57 - La Lucila. Vte. Lopez. Buenos Aires -.

CardioNerds Drs. Dinu Balanescu, Billy-Joe Mullinax, and Mariana Garcia discuss systemic thrombolysis in pulmonary embolism with expert Dr. Allison Burnett. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Pulmonary embolism is the third leading cause of cardiovascular death in the US, and high-risk PE carries a 30-day mortality risk as high as 30-50%. In this episode, we discuss the indications for systemic thrombolysis, including high-risk PE and cardiac arrest. We addressed how to appropriately select candidates for systemic thrombolysis, balancing the high risk of bleeding. Additionally, we discussed anticoagulation management and timing concurrent with lytic therapy, as well as the importance of multidisciplinary PERT teams.  The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Risk stratification is crucial in acute pulmonary embolism care. Based on the ESC 2019 guidelines, low-risk PE patients are those who are normotensive with no evidence of right ventricular dysfunction. Intermediate risk includes two categories: intermediate-low, with normotensive patients who have a high PE score with negative biomarkers, and intermediate-high risk, which has elevated biomarkers or signs of RV strain. High-risk PE includes hemodynamically unstable patients (SBP

Sex hormones shape cardiovascular risk in subtle yet powerful ways. From estrogen-driven changes in coagulation to formulation-specific differences in VTE risk, the nuance matters. Transdermal estradiol offers a safer path, while ethinyl estradiol reminds us that dose and route are destiny. The key is not avoidance—but precision: matching therapy to individual risk.   Three takeaways: • Formulation matters • First year matters • Patient factors matter   #Cardiology #Thrombosis #PrecisionMedicine #HormoneTherapy

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this episode, we have three new pieces of research that affect us in general practice. First: What interim anti-coagulation would you give your patient with suspected VTE? One common option has 5 times the rate of major bleeding.Second: How much muscle mass do people lose with weight loss on GLP1s? Is this different from lifestyle-based interventions, and is there anything patients can do about it?Third: Why don't we use clinical decision support tools for cancer? This research looks at the barriers and then I over-share my own thoughts on the subject...ReferencesNEJM Apixaban or rivaroxaban bleeding risk with acute VTEDiabetes, Obesity & Metabolism Lean mass loss with incretin therapies vs lifestyle interventionsBJGP: Why don't we use clinical decision toolswww.nbmedical.com/podcast

Welcome back to the tasty morsels of critical care podcast. Today we look at blunt cerebrovascular injury or BCVI. I added this to my list to cover for unclear reasons as when i looked back at my notes i had about 8 bullet points and a couple of referenced articles. So this will be shorter than usual I suspect. Effectively this refers to injuries to the carotids and vertebral arteries in the context of trauma. The pathology here is typically a pinch, twist or stretch of the vessel leading to an intimal tear in the vessel. The exposed endothelium then is a nidus for thrombus formation. The main downstream consequence is stroke and it’s a real shame to have a successful haemostatic and surgical resus of a major trauma patient only to have them suffer a life changing stroke 3 days into their hospital stay. They’re also pretty tricksy injuries as there are rarely obvious clinical signs to indicate their presence until they you find the dense hemiplegia, so this is one of those things were the term “index of suspicion” comes into play. It is especially important seeing as we have now effectively outsourced all diagnosis to the radiologists and these injuries are not picked up on the typical trauma pan scan that we so love. Given that I described the pathology of the injury as pinching, twisting and stretching we can probably get a sense of the mechanism of injury associated with these injuries. Top of the list here are c-spine injuries – if the neck has moved enough to break it you should think about the delicate blood vessels beside the c-spine. This is particularly pertinent to the vertebrals whose course, evolution in her wisdom, placed inside the tiny little vertebral foramen transversarium of the c spine itself. To make life more difficult for the poor little vertebrals they have to navigate a few 90 degree turns to get between C1 and the skull to get into the foramen magnum. This is reflected in the higher incidence of BCVI in high spine injuries. Obvious other associations are with severity of TBI and complex facial fractures (remember the carotid has to navigate its way past these). You might get some pointers to diagnosis from your clinical exam. Horner’s syndrome would be a classic (disruption to sympathetic neurons in the carotid) but if you’re diagnosing a Horner’s syndrome in your primary survey then you’re either over achieving or doing it wrong or possibly both. They may have stroke features on arrival which would be an obvious trigger for imaging. A bruit is also listed as a sign of injury but I think that’s a sign for better clinicians than you or I. Most of the time you will have an injured patient without specific symptoms of BCVI. Who do we pursue further imaging on given that I’ve already noted the initial trauma pan scan will often not pick up this? Enter stage left the geographically titled criteria each named after the academic centre that developed it. Denver, Memphis and Boston have all contributed a published criteria. The Denver criteria appear to be the most commonly used and referenced. I think listing the individual components is probably beyond the scope of the post but I’d emphasise the main headlines c-spine injuries facial fractures complex base of skull severe TBIs hanging Once you’ve decided the patient needs imaging then you should be reaching for our trusty friend the CT scanner. in this case a well done CT angiogram of the neck vessels extending into the intracranial vessels. It is not (unsurprisingly) a perfect test but it is a very good test and certainly where you should start. If you do find a BCVI you may even have the joy of seeing it classified I to V according to the wonderfully named Biffl classification system. It covers things like intimal tears and degrees of narrowing and occlusion. once you’ve found a BCVI it’s unclear who your go to specialist might be and I have seen vascular, neurosurgery and stroke all give opinions on treatment. Overall risk of stroke in BCVI is ~8% but changes significantly depending on grade with higher grades having higher stroke risk. For the vast majority of patients your treatment options come down to heparin vs aspirin. There does not appear to be a clear proven superiority of one strategy over the other. Some form of antithrombotic does, in observational data, seem to reduce stroke rate and is probably worth doing. Aspirin is generally easier delivered and seems to be the most common choice in our region. Many of the injuries would actually be amenable to surgical repair but the vast majority are surgically inaccessible hence the antithrombotic treatment as next best thing. The decision to give something that makes clotting more difficult in a patient who is either still bleeding or at risk of major bleeding is not an easy one. Hence there is typically a day or two of hand wringing amongst several specialties till we are all comfortable giving it. Observational work suggests that we’re likely a little overcautious on this in a similar way to our reluctance to commence VTE prophylaxis in TBI. Reading Doctor’s Little Helper Radiopaedia

Send us Fan MailWhich DOAC bleeds less in acute VTE?In this episode, we explore the COBRRA trial comparing apixaban vs rivaroxaban and what it means for clinical practice.The COBRRA trial provides the first direct, randomized comparison of apixaban and rivaroxaban for the treatment of acute venous thromboembolism (VTE).In this episode of CLOT Conversations, Dr. Lana Castellucci discusses findings from this landmark study and how they should influence anticoagulant selection.Key insights include:Apixaban reduced clinically relevant bleeding by more than 50% compared to rivaroxabanDifferences in bleeding risk emerged early and persisted over the 3-month treatment periodRecurrent VTE and mortality rates were similar between groupsDosing strategies and early treatment phase appear to play a key roleWe also explore real-world considerations, including medication adherence, patient preference, and how to approach populations not included in the trial, such as cancer-associated thrombosis and higher body weight.This episode provides practical, evidence-based guidance for clinicians managing acute DVT and pulmonary embolism. Listen now to learn how the COBRRA trial may change your approach to DOAC selection.Access the publication here:Castellucci LA, Chen VM, Kovacs MJ, Lazo-Langner A, Greenstreet P, Kahn S, Côté B, Schulman S, De Wit K, Douketis J, Suryanarayan D. Bleeding risk with apixaban vs. rivaroxaban in acute venous thromboembolism. New England Journal of Medicine. 2026 Mar 12;394(11):1051-60.Support 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

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

PQI Podcast | Season 10, Episode 4 Blood Clots and Cancer: What Every Oncology Team Should Know March is Blood Clot Awareness Month, making it the perfect time to spotlight an often overlooked but life-threatening complication in cancer care: blood clots. In this episode of the PQI Podcast, we speak with Leslie Lake, Voluntary President and Board Chair of the National Blood Clot Alliance (NBCA). After surviving a bilateral pulmonary embolism in 2018, Leslie became a passionate advocate for improving patient education, awareness, and prevention of venous thromboembolism (VTE). Her personal experience with limited information after discharge from the hospital inspired her to help ensure that other patients receive the knowledge and support they need. Leslie shares insights into the mission of the National Blood Clot Alliance and their national education initiative, Stop the Clot®, which works to increase awareness of blood clot risks, symptoms, and prevention strategies. The conversation also highlights why oncology teams should pay close attention to blood clot risk in patients with cancer, how healthcare professionals can better educate patients, and the role of advocacy and policy in improving outcomes. Listeners will learn practical strategies for patient education, key risk factors oncology teams should recognize, and how organizations like NBCA are working to improve awareness and prevention nationwide. Learn more at: www.stoptheclot.org

This week's episode we are back with our special guest & thrombosis expert Dr. Marc Carrier.  In part 2, we discuss additional special considerations like IVC filter indications, and management of VTEs in the setting of thrombocytopenia. We also discuss VTE prevention in patients with cancer, the Khorana score, exciting research to come in this space, and career advice.

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

The JournalFeed podcast for the week of Feb 16-20, 2026.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday's Spoon Feed:Using Wells-based pretest probability with an age-adjusted D-dimer safely ruled out lower-extremity DVT in ED outpatients with zero 3-month VTE events among patients between the conventional and age-adjusted cutoffs.Friday's Spoon Feed:This evidence-based expert position statement on necrotizing soft tissue infections (NSTIs) provides best practices for assessment, diagnosis, treatment, antimicrobials, adjunctive therapies, and long term management.

In this week's episode, Blood editor Dr. Laurie Sehn interviews authors Drs. Julie Jaffray and Ulrike Philippar on their latest articles published in Blood. Dr. Jaffray discusses her CME article, "Multisite validation of a venous thrombosis risk model in critically ill children through the CHAT Consortium", identifying patients with risks as high as 17% and taking research one step closer to the goal of personalized thromboprophylaxis for safe and effective care of high-risk children. Dr. Philippar discusses her article "Ramantamig (JNJ-79635322), a novel T-cell-engaging trispecific antibody targeting BCMA, GPRC5D, and CD3, in multiple myeloma models", where the extensive in vitro and in vivo preclinical studies with cell lines and patient samples indicate strong potential for this agent to have efficacy against MM expressing either or both of these antigens.

Learning Objectives:By completion of this program, attendees will be able to:Evaluate VTE risk factors in medical patients and apply appropriate prophylaxis strategies.Develop a management plan for VTE prophylaxis in post-surgical patients, including considerations for bleeding risk.Analyze VTE prophylaxis recommendations specific to neurosurgical and orthopedic populations.Apply VTE prevention strategies in trauma patients while considering contraindications and optimal dosing.Speaker:Thomas Vendegna, MD, CMO, Central Coast, California MarketModerator:John Morelli, MD, System Vice President, Acute Care Clinical Service Line, Physician EnterprisePanelists:Christian Chiavetta, DO, FACOI, FACP, SFHM, Medical Director, Northridge Hospital Medical CenterRuby Skinner, MD, FACS, CMO, Community Hospital of San BernardinoWilliam Wang, MD, DrPH, CPE, CMO, Glendale Memorial Hospital and Southern California MarketWyndham Strodtbeck, MD, System Vice President, Anesthesia and Perioperative Medicine, Physician Enterprise

Kiera is joined by the tooth-healer himself, Jason Dent! Jason has an extensive background in pharmacy, and shares with Kiera where his pharmaceutical experience has bled over into dentistry. This includes the difference between anti-quag and anti-platelet and which medications are probably safe, what to do to shorten the drag time in the pharmacy, how to write prescriptions most efficiently, and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00) Hello, Dental A Team listeners. This is Kiera and today is a really awesome and unique day. It is, think the second time I've had somebody in the podcast studio with me live for a podcast and it's the one and only Jason Dent. Jason, how are you? I'm doing well. Good morning. Thanks for having me. It is crazy. I I watch Instagram real like this all the time where people are like in the podcast and they're hanging out on two chairs and couches and now look at us. We're doing it. Cheers. Cheers.   That was a mic cheer for those of you who are only listening, but yeah, Jace, how does this feel to be on the podcast? It's weird. Like I was not nervous at all talking about it. I got really nervous as soon as you hit play. So if I stumble over my words, please forgive me ahead of time. Well, Jason, I appreciate you being on the podcast because marketing had asked me to do a topic about teledentistry and I was like, oh shoot, that's like not my forte at all. so   You and I were actually chatting in the hot tub. call it Think Tank session and you and I, we have a lot of good ideas that come from that Think Tank. A lot of business. no phones. That's why. We do leave our phones out. But I was talking to Jason and this is actually a podcast we had talked about quite a while ago. Jason has a lot of information on pharmacy. And if you don't know, Jason isn't really, we were going through all of it last night. It's kind of a mock in the tub. And I think it's going to be great because I feel like this is an area, I'm working at Midwestern and   knowing about how dentists, pharmacology was surely not your favorite one. Jason actually helps a lot of dentists with their clearances. And so we were talking about it and I like it will just be a really awesome podcast for you guys to brush up on pharmacology, different things from a pharmacist's side. So Jason, welcome. Thank you. Yeah, no, we were talking about it and here's like, what should I talk about on the podcast next? I have all these different topics and she's like, what do you know? And the only real interaction I have with dentists is doing clearances for procedures. We get them all the time, which makes sense.   Lots of people are on blood thinner, I've always told Kiera, like, hey, I could talk about that. Like, that's kind of a passion of mine. I'm not a dentist. Or my name is Jason Dent. So in Hebrew, Jason means tooth. No, no, no, sorry. Nerves are getting to me. Jason means healer and Dent means tooth. So my name means tooth healer. So, here's a little set. Hold on, on, hold Can we just talk about? I brought that up before you could talk about it more. So.   My name means tooth healer but I did not become a dentist. I know you wanted me to become a dentist. did. I don't know why. I enjoy medicine. I know what you're going to get to already. The things you're going to ask me. There's been years of this. But nevertheless, that's my name. We'll get that out of the way. But you did give me a great last name. So I mean, it's OK. You're All is fair and love here. SEO's up for that. But yeah, Jason, I'm going to get you right into the show. And I'm going to be the host. And we're going to welcome to the podcast show. Jace, how are you?   Good, good, good. Good, good, good. So by getting into clearances, right? This is what you're kinda talking about with you know, before we get to clearances, I actually wanted Jason, for the listeners who don't know you, who haven't talked to you, who don't know, let's kinda just give them like, how did you go from, Kiera wanted you to be a dentist, to now Jason, you are on the podcast talking as our expert on pharmacy. fantastic. I've always really loved medicine, a ton. As a kid getting headaches and taking Excedrin, like you just feel like a miserable pile of crap.   and then you take two pills and all of a sudden you feel better. Like that's amazing, like how does that happen? Also getting ear aches as a kid, just being in so much pain and then taking some medicine and you start feeling a lot better. I always had a lot of appreciation for that. I've always been mechanically inclined. I went to, started doing my undergrad and took biology and learned about ATP synthase, which is a spinning enzyme that's inside the mitochondria, like a turbine engine. I used to work on small engines on my dirt bike and thought that is so cool. So I really got wrapped up into chemistry.   All the mechanics of chemistry really pulled me in. I'm not getting goosebumps. checking. I usually get goosebumps when I think about chemistry. But it's so cool. You think an engine's awesome, like pistons and camshafts and pressures, the cell is the same thing. It's not as loud, so it's not as cool. But it's fascinating. that's why we're like. ⁓   chemistry and really got into coagulation. So I did my residency after pharmacy school. we went to Arizona for three years. ⁓ You did and your main focus, you were never wanting to be the guy behind the counter. No, I haven't done that. Yeah. No, I love them though. I've always really want to go clinical. ⁓ But I love my retail ⁓ pharmacists. They're amazing resources. And ⁓ I use the retail pharmacist every day still to this day, but I went more the clinical route, really love the chemistry aspect of it.   did my doctorate degree and then I did my residency in Reno. Reno's kind That's how we got here everybody. Welcome to Reno. Strategically placed because I was really interested in critical medicine and where we're located we cover a huge area. So we pull in to almost clear, we go clear to Utah, clear to California, all of Northern Nevada. We get cases from all over. So we actually are kind like the first hub of care for lot of areas. So we really get an eclectic mixture of patients that come in that need-   all kinds of different cases that are coming to them. So it's what I really wanted. So I did my residency in critical care there. And then for the next 10 years, I worked in vascular medicine with my final five years being the supervisor of the clinic. Ran all the ins and outs of that. So my providers, two doctors were on our view. So when we talk about dentistry, talk about production, those kinds of things, totally get it. My doctors were the exact same way, my vascular providers. ⁓   There's some pains there, right? You wanna be seeing patients as much as possible, being able to help as many people, keeping the billing up. And had other nurse practitioners, four practitioners, a fleet of MAs, eight pharmacists. We also had that one location we had, going off the top of my head, I think we had eight locations running as well. And we took care of all the different kinds of vascular cases that came to us. Most common was blood clots, ⁓ which is just a...   which is an easier way of saying VTE. There's so many different ways to say a blood clot. Like you might hear patients say, I've had a PE or a DVT or a venous thromboembolism or a clot in my leg, right? They're all clots, but in different locations. Same with an MI, and MI can be a clot as well. ⁓ there's a lot of, everybody's kind of saying the same thing, but sometimes the nomenclature can make it sound hard, but it really is actually pretty simple.   No. And Jason, I love that you went through, you've been in like, and even in your, ⁓ when you were getting your doctorate, you were in the ER. You also worked in retail pharmacy. remember you having a little sticker on your hand. And retail pharmacy, I have a lot of respect for those guys. They have a lot of pressure on them. and then you also, ⁓ what was that test that you had to take that? I don't know. You were like studying forever for it. ⁓ board certification for, ⁓ NABP. Yeah. So I did that board certification as well.   And now you've moved out of the hospital side onto another section in your career. Now in the insurance, right? So it's really, really interesting. So now I'm on the other side reading notes and evaluating clinical appropriateness and trying to help patients with getting coverage and making those kinds of determinations. So yeah, I've really jumped all over. Really love my clinical days. I know. don't I don't I do miss them. But yeah, kind of had a good exposure to a lot of.   pharmacy a lot a lot of dentists actually with all the places that come through which Jason I really appreciate that and honestly I know you are my spouse and so it's fun to have you on but when I go into conversations like this I don't know any of this information and so finding experts and Jason I think here's me talk more about dentistry and my business than I do hear about him on pharmacy so as we were chatting about this I really realized you are a wealth of knowledge because you've been on the clinical side so you've done a lot of patient care and you've seen how   medications interact and I know you've had a few scares in your career and ⁓ you've known some physicians that have had a few scares and ⁓ you've seen plenty of patients pass away working in the ER and gosh in Arizona drownings were such a big deal. I remember when you were in the ER on your rotations I'd be like who died today? Like tell me the stories and you've really seen and now going on to the insurance side I felt like you could just be such a good wealth of knowledge because I know dentists are sometimes so   I would say like maybe just a little more anxious when it comes to medications. I know that dental students from Midwestern were like here was like four months and we had to like pass it, learn it. And Jason, you've done four years plus clinical residency, plus you've been in it. And something I really love about Nevada Medicine is they've been so collaborative with you.   like your heart, your cardiologist, they diagnose and then they send to you to treat with medicine and... Yeah, I've been really lucky being here in Reno too. The cardiology team has been amazing to work with. We started a CHF program, sorry, congestive heart failure program for patients. So we would collaborate with cardiologists. They'd see the cardiologists and then they send them to the pharmacist to really manage all the medications. So there's pillars of therapy ⁓ called guideline directed medical therapy and the pharmacist would take care of all that. So that's gonna be your...   your beta blockers, your ACEs, your ARBs, your Entresto, which would be a little bit better, spironolactone. So just making sure that all these things are dosed appropriately, really monitoring the heart, and make sure that patients are getting better. we've had real positive outcomes when the, sorry, this is totally off topic. do, talk about that study. When we looked at when patients were coming to see our pharmacists in our clinic that we started up, the patients were half as likely to be readmitted. And this was in 2018, and our pharmacists,   We're thinking about all the medications. We're usually adjusting diabetes medications too at the same time. Just kind of naturally just taking care of all the medications because we kind of got a go ahead from the providers, a collaborative practice agreement that we could make adjustments to certain medications within certain parameters. So we weren't going rogue or maverick, but we were definitely trying to optimize our medications as much as possible. And then years later, some studies came out with, I'm sure you've seen Jardins and Farseegh. not trying to, I'm not.   I don't get any kickback from them. I have no conflicts to share. But because our pharmacists were really optimizing that medication, those medications were later shown to reduce hospitalizations and heart failure, even though they're diabetes medications. Fascinating. So it wasn't really the pharmacists. It was just the pharmacists doing as much as they can with all the tools that were in front of them. And then we found out that the patients were going back to the hospital.   half as much as regular patients. So, yeah, being here, it's been so amazing to work with providers here. the providers here want help, want to help patients, don't have an ego. I mean, I just, it's awesome. I love it. I do love how much I think Jason sees me geek out about dentistry and I watching Jay's geek about his pharmacy and how much he loves helping patients. And ⁓ really that was the whole idea of, all right.   Dentistry has pharmacy as a part of it. And I know a lot of dentists are sending in clearances and I know working in a chair side, it would be like, oh no, if they're on warfarin or on their own blood clot, you guys, honestly don't even know half of what I'm talking about because this is not my jam, which is why Jason's here. But I do know that there was always like, well, we got to talk with their provider. And so having Jason come in and just kind of explain being the pharmacist that is approving or denying or saying yes or no to take them off the blood thinners in different parts, because you have seen several dental   I don't know what they're called. What is it? Clarence's? that what comes to you? don't even know. All day my mind, it's like, here is the piece of paper that gets mailed to you to the pharmacist and then you mail it back. So whatever that is. But Chase, let's talk about it because I think you can give the dentist a lot of confidence coming from a pharmacist. What you guys see on that side. When do you actually need to approve or disapprove? Let's kind of dig into that. Yeah. Well, first of all, I think I'm not a replacement for any kind of clinical judgment whatsoever. Every patient's different. But the American Diabetes Association, you   I work with diabetes a lot. American Dental Association has some really great guidelines on blood thinners and I would always reference them. I actually looked at their website today. Make sure I'm up to speed before I get back on this again. They have resources all around making decisions for blood thinners. And I think the one real important thing in putting myself in the shoes of a dentist or any kind of staff that's around a patient that's in a chair, if they say I'm on a blood thinner, right, a flag goes up. At least in my mind, that's what goes up.   Like, okay, how do we get across this bridge? And I think the important thing to really distinct right then when they say they're on a blood thinner is that is kind of a slang word for a lot of different medications, right? Like it's the overarching word that everybody pulls up saying, I'm on a blood thinner. It's like, okay, but I don't know what say. It's like, I have a car. You're like, okay, do you have a Mazda? Do you have?   Toyota, Honda, what do you have? or even worse it'd be like saying I have a vehicle, right? So when somebody says they're on a blood thinner, it opens up a whole box of possibilities of what they're Blood thinners are also, doesn't, when they're taking these types of medications that are quote unquote a blood thinner, it doesn't actually thin the blood, like adding water to the blood, if that makes sense, or like thinning paint, or like thinning out a gravy, right? It doesn't do the same thing. Blood thinners, really what they're doing is they're working on the blood, which.   which is really cool, try not to tangent on that. ⁓ When they're working on the blood, it's not thinning it per se, but it's making it so that the proteins or platelets that are in it can't stick together and make a cloth quite as easy. So whenever somebody's on a blood thinner, I usually ask, what's the name of the blood thinner that you're on? It's not bad that they use that slang, that's okay, on the same page, but it's really broken into two different classes. There's anticoagulant and antiplatelet.   And a way to kind of remember which is which, when residents would come through our clinics, the way that I teach them is a clot is like a brick wall. You know, it's not always a brick wall. Usually the blood is a liquid going through. But once they receive some kind of chemical message, it starts making a brick wall with the mortar, which is the concrete between the and the bricks, the two parts. When it's an anti-quagent, it's working on that mortar part. When it's an anti-platelet, it's working on the bricks part, right? You need both to make a strong clot or strong brick wall.   But if you can make one of them not work, obviously like if your mortar is just water, it's not working, right? You're not gonna make a strong brick wall. So that's kind of the two deviants right there. So that's what I do in my mind real quickly to find out because antiplatelets are usually, so that's gonna be like your Plavix, Ticagrelor, Brilinta. And hold on, antiplatelets are bricks? Good job, bricks. They're the bricks. And so the reason I was thinking you could remember this because I'm, antiplatelets, it's a plate and a plate is more like a brick.   And anti coagulant, I don't know why quag feels like mortar to me, like quag, like, know, it's like slushy in the blood, like it's coagulating. It's a little bit of that, like, honestly, I'm just thinking like coagulated blood is a little bit more mortar-ish. And so platelet is your plate, like a brick, and anti-quag is like.   the gilly between the bricks. Okay, okay, I got it. Yeah, so there's an exception to every rule, but when they're on that Don't worry, this is Kiera, just like very basic. You guys are way smarter listening to this, and that's why Jason's here. No, no, you helped me pass pharmacy school. When we were doing all the top 200, you helped me memorize all know what flexorill is, all right? That's a muscle relaxant. Cyclo? I don't know that part. It's a cyclo, because you guys are cycling and flexing. I don't actually know. just know it's a muscle relaxant, so that's about as far as I got. When we're looking at antitick platelets, so that's the brick part, so that's going to be your, you know,   Hecagrelor, Breitlingta, Clopidogrel is the most common one. It's the cheapest one, so probably see that one the most. Those, I mean, there's an exception to every rule, but that's generally being used after like a stent's placed in the heart. It can be used for VTE, there's some out there, but that's pretty rare. But also for some valves that are placed in the hearts, it can be used for that as well. So antiplatelet, really thinking more like a cardiac event, right? Like I said, there's always an exception to every rule, but that's kind of where my mind goes real quickly, because we're gathering information from the patient.   They're on anticoagulant. Those are like going to be the new ones that you see commercials for all the time. So Xeralto, Alequis, those are the two big ones right now. They're replacing the older one. And also we were supposed to do a disclaimer of this is current as of today because the ADA guidelines do change. this will be current as of today. And Jason, as a pharmacist, is always looking up on that. I had no clue that you are that up to speed on dental knowledge. so just throwing it out there that if you happen to catch his podcast,   a few years back that obviously check those guidelines for sure. But the new ones are the Xarelto and Eloquist. They're replacing the older ones of warfarin. Warfarin's been around for a really long time. We've seen that one. Those are anti-coagulants. So when you're looking, when a patient says that, generally they're on that medication because they've possibly had a clot in the past or they have a heart condition called atrial fibrillation. Those are kind of the two big ones. Like I said, there's always caveats to it, but that's kind of where my mind goes real quickly. And then,   as far as getting patients cleared, the American Dental Association has really good resources on their website. You can look at those and they're always refreshing that up. They even say in their own words that there's limited data around studying patients in the dental chair and with anticoagulants or anti-platelets. It's pretty limited. There's a few studies, some from 2015, some from 2018. There's one as recent as 2021, which is nice. But really, all of those studies come together and it's really more of an expert consensus.   And with that expert consensus, they have kind of simplified things for dentistry, which is really nice. ⁓ comparing that to, we have more data for like total hip replacement, total knee replacement. We have a lot of data and we know really what we should be doing around then. But going back to dentistry, we don't have as much information, so they always say use clinical judgment, but they do give some really great expert guidance on that. So if a patient's on an anticoagulant, ⁓   they generally recommend that it doesn't need to be stopped unless there's a high bleeding risk for a patient. as a provider or as a clinician in the practice, you can be looking at high bleeding risk. Some things that make an oral procedure a little bit lower risk is one, it's in the compressible site, right? Like we can actually put pressure on that site. That's the number one way to stop bleeding is adding pressure. It's not like it's in the abdominal cavity where we can't get in and can't apply pressure. So number one, that kind of reduces the bleeding risk.   is number one. Two, we can add topical hemostatic agents. Dentists would know that better than me. There's a lot of topical ways to do that. So not only pressure, but there's those things as well. And also, but there are some procedures that are a little bit more likely to bleed. And that's where you and dentists would come in hand in What's the word in APO? Oh, the APOectomy. I got it right. Good job. like, didn't you tell me last night that the ADA guideline was like what?   three or four or more teeth? great question. So you can extract one to three teeth is what their expert consensus One to three teeth without. Without really managing or stopping anticoagulation or doing anything like that. I think that's some good guidance from them. I'm gonna add a Jasonism on that though. So with warfarin, I do see why dentists would be a little bit more conservative or worried about stopping the warfarin because warfarin isn't as stable as these newer agents. Warfarin, the levels.   quote unquote levels can go really high, they can go really low. And if the warfarin levels are high, they're more likely to bleed. So I do think it makes sense to have a really recent INR. That's how we measure what the warfarin's doing. I think that makes a lot of sense, but the ADA guidelines really go into the simplification version of all these blood thinners. Generally, it's recommended to not stop them because the risk of stopping them outweighs the benefit of stopping them in almost every case. Almost every case.   ⁓ So when you're with that patient, right, they say I'm on a blood thinner, finding out which kind of blood thinner that they're on, you find out that they're on Xeralto, right? How long have you been on Xeralto for? I've been on it for years. You don't know exactly why, but if they haven't had any recent bleeding, you're only gonna remove one tooth. ⁓ You can do what's called a HasBlood score. That kind of looks at the bleeding risk that they'd have. That'd be kind of going a notch above, but in my mind, removing one tooth isn't a real serious bleeding risk. I'd love to hear from my dentist friends if they...   disagree, right, but ADA says one to three tooth removals, extractions, that's the fancy word. Extractions, yeah, for extracting teeth out. Is not really that invasive. Sure. It's not that high risk, so it's usually perfectly fine. So if a patient was on Xarelto, ⁓ no other, this is in a vacuum, right? I'm not looking at any other factors, which you should be looking at other factors. I would be perfectly fine to just remove one to two.   And when those clearances come in, because dentists do send them, talk about what happens. You guys were working in the hospital and you guys would get these clearances all the time. do. We get them so often. I mean, we get like four or five a day. We'd love to give it to our students, student pharmacists, and ask them what to do. And they would usually look up the American Dental Association guidelines and come up with something. We're like, yep, that's what we say too. In fact, we say it so many times a day that we have a smart phrase.   which just blows in the information real quickly and faxes it right back to the So it's like a copy paste real quick. So what I wanted to point out when Jason told me this is dentists like hearing this and learning this, this can actually save you guys a ton of time to be able to be more confident, to not need to send those clearances on. And we were actually talking last night about how I think this might be a CYA for dentists. like, as we were talking, I think Jason, you seeing so many other aspects of medicine, like you've literally seen patients die, you've seen other areas.   And so coming from that clinical vantage point, we were realizing that dentists, we are so blessed to live in an injury. I enjoy dentistry because possibly there's someone dying, not super high, luckily in dentistry. The only time that I have actually had a doctor have a patient pass away, and it was only when they were completely sedated and doing ⁓ some other things, but that was under the care of an anesthesiologist. And so that's really our high, high risk. And so hearing this, Jason,   That was one of the reasons I wanted him to come on is to give you doctors more confidence of do we have to always send to a pharmacist? I mean, hearing that on the pharmacy side, they're just sending these back and not to say to not see why a to not cover this because you might be questioning like, well, do I really need to? But you also were talking about some other ways of so number one, you guys are just going to copy back the 88 guidelines. So so 88 guidelines. Yeah. And I think that that gives a lot of confidence to a provider or a dentist is that you can go to the 88 guidelines and read them, right? Like you're listening to some   nasally monotone pharmacist on a podcast. Rumor has it, people love him at the hospital. were like, you're the voice, he's been told he has a good radio So for the clinic, I was the voice. Like, yeah, you've reached the vascular clinic, right? And they're like, oh my gosh, you're the voice. But sorry, you me distracted. That'll be your next career, Jace. You're going to be a radio host. OK. I would love that. I love music. But you're hearing from a nasally guy, but you can actually read the ADA guidelines. You just go right to the ADA, click on Resources, and under Resources, it has the   around anticoagulants, I think that's the best way to get a lot of confidence about it because they have dentists who are the experts making calls on these. I'm just reiterating what they say, but I think it makes a lot of sense to help providers. And the reason why my heart goes out to you as well is having the providers that used to work underneath me, they're always looking for our views, which is a fancy way of making sure that they're drilling and filling. Can I say that? Yeah, can say drilling and filling. They're being productive, right? They're being productive, right?   They're always looking to make sure if a patient's canceling, like get somebody in here. Like I need to be helping people all day long. That's how I, we keep the lights on. That's how I help as many people. And so if you have a patient coming in the chair and it has an issue, they say I'm on Xeralto. Well, you can ask real quickly, why are you on Xeralto? I had a clot 10 years ago. my gosh. Well, yeah, we're pretty good to go. Then I'm not worried. We're only removing one tooth or we're just doing a cavity or a cleaning. Something like that. Shouldn't be an issue whatsoever because there's experts in the dental. ⁓   in the dental society, the ADA guidelines that recommend three teeth or less, minimally invasive. They really recommend if it's gonna be really high bleeding risk. And clinically, that's where you would come in, ⁓ or yourself. know, apioectomy is one that's like on the fence line. I don't know where implants set. though, and like we were talking, implants aren't usually like a date of procedure. Most people aren't popping in, having tooth pain, and we're like, let's do an implant. Now sometimes that can be the case, but typically that one's gonna have   a few other pieces involved. And so that is where you can get a clearance if you want to. ⁓ But we were really looking at this of like so many dentists that I know that you've seen will just send in these clearances because they are. And I think maybe a way to help dentists have more confidence is because you know, I love routines. I love to not have to remember things. So why don't we throw it in, have the team member set it up where every quarter we just double check the ADA guidelines. Are there any updates? Are there any other things that we need to do on that? That way you can just see like   getting into the language of this, of what do I need to do? Because honestly, you guys, know pharmacy was not a big portion for it, so, recommending different parts, but I think this is such a space where you can have confidence, and there's a few other things I wanna get to, and I you- I some pearls too. Okay, go. I'm so when she get me into talking about drugs, I'm not gonna stop. So, some other things around that too is these newer blood thinners like Xarelto Eloquist, they now have reversal agents, so a lot of providers in the past were really worried about bleeding because we can't turn it off. We can turn those off. Warfarin has reversal as well, right?   So I'm looking at these patients. It's really low risk. It's in the mouth, generally speaking. Very rarely are they a high bleeding risk. Now if you're doing maxillofacial surgery, this does not apply, right? This does not apply whatsoever. you're like general dentist, you're pediatric dentist. Yeah, yeah, and it's kind of on the fly. So just trying to really help you to be able to take care of those patients on the moment, have that confidence, look at the ADA guidelines, have that in front of you. I don't think it's a bad thing to ever...   check with their provider if you need to. If you're thinking, I feel like I should just check with the provider, I would never take that away from you. But I just want to kind of steer towards those guidelines that I have to help. But what did you want to share? No, yeah, I love that. And I think there were just a few other nuggets that we were chatting about last night that can help dentists just kind of get things passed a little bit easier. So you were mentioning that if they were named to their cardiologist, what was it? was like, who is the last? Great question. Yeah, when a patient's on a blood thinner,   It could be prescribed by the cardiologist. It could be prescribed by the family provider or could have been punted to like a vascular clinic like where I was working. It can go to any of those. And when you send that fax, right, if it goes to the cardiologist and it's supposed to go to the family care provider, like it just kind of goes, goes nowhere, right, from there. So I think it's a really good idea to find out who prescribed it last. If the patient doesn't know who prescribed their blood thinner last, you can call their pharmacy. I call pharmacies all day long.   I have noticed in the last year, they are way easier to get a hold of, which has made my job a lot easier, working on the insurance portion. So reaching out to the pharmacy, finding out who that provider is and sending it to them, because they should be able to help with that. I thought that was a good shift in verbiage that you had of asking instead of like the cardiologist, because that's who you would assume was the one. But you said like so many times you guys would take care of them, and then they go back to family practitioner, and you guys would get the clearances, but you couldn't clear because you weren't overseeing. So just asking the patient.   who prescribed their medication for them last time. That way you can send the clearance to the correct provider. then- And they might not know. You know patients, right? They're like, I don't know, my mom's or else, I don't know who gave it to me. Somebody told me I need to be on this. But at least that could be another quick thing. And then also we were talking last night about-   ⁓ What are some other things that dentists can do when like writing scripts to help them get what I think like overarching theme of everything we discussed is one how to help dentists have less I think drag through pharmacy. ⁓ Because pharmacy can take a little while and so perfect we now know the difference between anti-quag and anti-platelet. We know which medications are probably safe. We know we can check the ADA guidelines so that we were not having to do as many clearances. We also know if they're on a medication to find out and we do need a clearance.   who we can go to for the fastest, easiest result. And now, in talking about prescriptions, you had some really interesting tips that you could share with them. Yeah, so with writing prescriptions, right, pharmacies are pharmacies. So I'm not gonna say good thing or bad thing. There are challenges working with pharmacies. I'm not gonna play that down at all. ⁓ If you're writing prescriptions and having issues and kickbacks from pharmacies, there's some interesting laws around ⁓ writing prescriptions. Say that you're trying to ⁓ prescribe   augmentin, you know, 875 BID, and you tell the patient, hey, I want you to take this twice a day for seven days, and then you put quantity of seven, because you're moving fast, right? You want it for seven days, quantity of seven. Quantity would actually be 14, right? It's not that big of a deal. Anybody with common sense would say if you're taking a pill for twice a day for seven days, you need 14 tablets. But LAHA doesn't allow pharmacists to make that kind of a change, unfortunately. They have to follow what you're saying there. So you're going to get a...   An annoying callback that says, you wrote for seven tablets. I know you need 14. Is that OK? Just delays things, right? So ⁓ I really like the two letters QS. That's Q isn't queen. S isn't Sam. Yeah. It stands for quantity sufficient. So you don't have to calculate the amount of any medication that you're doing. So for me, as a pharmacist, when I was taking care of patients, I hated calculating the amount of insulin they would need for an entire month. So I would say.   Mrs. Jones needs 15, I'd say 15 units ⁓ QD daily. ⁓ And then I say QS, quantity sufficient, ⁓ 90 day supply through refills. So the pharmacy can then go calculate how much insulin that they need. I don't have to even do that. So anytime you're prescribing anything, I like that QS personally. So that lets the pharmacy use ⁓ common sense, as I like to call it, instead of giving you a call. I think that's super helpful. I also thought of one thing too.   going back to blood thinners is when it's kind of like a real quick, like they're not gonna have you stop the blood thinner at all. like you're seeing if you can stop the blood thinner for a patient, there's some instances it's just not gonna happen. And that's whenever they've been, they've had a clot or a stroke or a heart attack within the last three months. Three months. Yeah, that's kind of like the.   Because so many people are like, they had a heart thing like six years ago. And so I think a lot of my dentists that I worked with were like, we got to stop the blood thinners. But it sounds like it's within three months. Yeah, well, I'm just the time. Like this is general broad strokes. What I'm just trying to say is when you want to expect a no real quick. Got it. Right. So because benefits of stopping a blood thinner within those first three months of an event is very, very risky versus the, you know, the benefit of reducing a little bit of blood coming out of the mouth. Right. Like that's not that bad.   when somebody's had a stroke or a heart attack or pulmonary embolism, a clot in the lung, like we can't replace the lung, heart or brain very easily. We can replace blood a lot better. We've got buckets of it at most hospitals have buckets of it, right? So I'm always kind of leaning towards I'd rather replace blood than tissue at all times. So that's kind of a quick no. If they've had one those events in the last three months, we are really, really gonna watch their brain instead of getting.   root canal, right? Like really worried about them. So you'll just say no. And they could the dentist still proceed with the procedure or would you recommend like a three month wait? Or is it provider specific way the pros and cons because sometimes you need to get that tooth out. Great question. think then it's going to come into clinical. That's that's when you send in the clearance, right? Like, and it's great to reach out to the provider who's managing it for you. But I think it's kind of good to know exactly when you get a quick no quick no is going to be less than three months.   ⁓ Or when it's going to be like a kind of a typical, yeah, no problem. If it's been no greater than six months, they're on the typical anticoagulants or alto eloquence. Nothing crazy is going on for them. You're only removing two teeth. This is very, very low risk. But again, I'd urge everybody to read the ADA guidelines. That way you feel more comfortable with it. I'm not as eloquent as they do. They do a real good job. So I don't want to take any of their credit. I think they do a real good job of simplifying that and making you feel confident with providing.   more timely care for patients. Which is amazing. And Jayce, one last thing. I don't remember what it was. You were talking about the DEA and like six month rule. yeah. Let's just quickly talk about that and then we'll wrap this because this is such a fascinating thing for me last night. Yeah. So when comes to prescribing controlled substances, most providers have to have a DEA license. OK. First of all, though, what's your take on dentist prescribing controlled substances? ⁓ I don't think, you know, I worked on the insurance side of things. Right. And I look at the requirements for the   as the authorizations, what a patient, the criteria a patient needs to hit in order to qualify for certain medications. A lot of times for those controlled substances, they have pretty significant issues going on, like fibromyalgia or cancer-related pain or end-of-life care versus we don't, in all my scanning thread, I don't have a ⁓ perfect picture memory. Sure. But I don't usually see oral.   pain in there. There is some post-operative pain that can be covered for those kind of medications but I really recommend to keep those lower and in fact in a lot of our criteria it recommends you know have they tried Tylenol first, they tried, have they filled NSAIDs or are they contraindicated with the patient. So really they should be last line for patients in my two cents but there's always going to be a caveat to the rule right? Of course. comes through that has oral cancer and you're taking   like that would make sense to me. Got it, so then back to the DEA. Yeah, okay. Okay, ready. So as a provider, you should be checking the, if you're doing controlled substances, you should be checking the prescription drug monitoring program, or sometimes called the PDMP, looking to see if patients are getting ⁓ controlled substances from another provider. So it's really just a check and balance to make sure that they're not going from provider to provider to getting too many narcotics and causing self harm or harm to others.   And so with checking that PDMP before prescribing, I think a lot of providers do that. A lot of softwares that I'm aware of, EMRs, electronic medical records, sometimes have links so that you can do that more quickly. However, I don't think it's as intuitive that they need to be checking that every six months in some states. And like here in Nevada, you're supposed to be checking it every six months, not for a patient, but for your actual DEA registration to see if anybody else is prescribing underneath you. Because if you don't check that every six months, you could get in some serious trouble with...   not only DEA, but even more the Board of Pharmacy and your state. Now, I don't know all 50 states, so I check with your state to see if you need to be checking that every six months, but set an alarm just to check that real quickly, keep your nose clean. ⁓ I've had providers, I've had to remind to do that. And if somebody was using your account, prescribing narcotics, you'd never know unless you went and checked that PDMP.   Yeah, I remember last night you were like, and if that was you, I would not want to be you. The Board of Pharmacy is going to be real excited to find you. So that was something where I was like, got it. So, and we all know I'm big on let's make it easy. And Jason, I love that you love this so much and you just brought so much value today. And like also for me, it's just fun to podcast. fun. Yeah. But I got a nerd out on my world a little bit. Bring it into yours. I work with dentists or at least you know, when I was working in Vascular Clinic all day long. Great questions that would come through. Yeah.   So I think for all of us, as a recap on this is number one, I think setting yourself ⁓ some cadences. So maybe every quarter we check our ADA guidelines and we check our, what is it, PDMP. PDMP. so each state, so they call it Prescription Drug Monitoring Program. We need that. Yeah, but there are different acronyms in different states, though. That's just what it's called in Nevada. I forget what it is in California, but you can check your state's prescription monitoring program, make sure that opioids aren't being prescribed under your name. Got it. So we just set that as a cadence.   We know one to three teeth most likely if they're on a blood thinner is According to the 88 as of today is good to go You know things that are going to get a quick know are going to be within the last three months of the stroke the heart attack or the Clot I'm thinking like the pulmonary embolus. Yeah, that's what we're trying to prevent   Those are gonna be quick knows and then if we're prescribing, let's do QS. We've got quantity is sufficient so that we're not getting phone calls back on those medications that we are. And then on narcotics, just being a bit more cautious. Of course, this is provider specific and in no way, or form did Jason come on here to tell you you are the clinical expert.   Jason's the clinical expert on medications. And if you guys ever have questions, I know Jason, you geek out and you want to talk to people so that anyone wants to chat shop. Be sure to reach out and we'll be able to connect you in. we've even talked about possibly, so let me know listeners. You can email in Hello@TheDentalATeam.com of ask a pharmacist anything. I talked to Jason. I was like,   We'll just have them like send in questions and maybe get you back on the podcast or we do a webinar. But any last thoughts, Jace, you've got of pharmacy and dentistry as we as we wrap up today? No, I think that's pretty much it. So check the ADA guidelines. I think it's really good to have cross communication between professions. Right. If you're working with the pharmacy, CVS, Walgreens or something like that or Walmart, I know that it can be challenging. Right. They're under different pressures. You're under different pressure. So I think ⁓ just coming in with an understanding, not being angry at each other.   you know what mean, is super beneficial and working together. When it comes to it, every dentist that I've talked to is actually worried about their patient. Every pharmacist that I've worked with is really worried about the patient as well. So we're trying to accomplish the same thing, but we have different rules and our hands are bound in different ways that annoy each other, right? Like I know Dr. Jones, want 14 tablets, but you said seven. And I know Common Sense says I should give them 14, but I've got to make that change.   knowing that their hands are tied by the law. They can't use as much common sense, which is aggravating. I mean, that's why I love what I gotta do here. I gotta just kind of help a lot more and use common sense and improve patient care. But those kinds of things I think are really beneficial as you work together and then not being so afraid of blood thinners, right? So I think those guidelines do a great job of giving you confidence and not worrying about the side effects. And there's a lot of things that you can do locally for bleeding.   You have a lot of control over that. I think that's pretty cool, the tools they have. Yeah. And at the end of the day, yes, you are the clinician. You are the one who is responsible for this. so obviously, chat, but I think collaborating, talking to other pharmacists, talking to them in your state, finding out what are the state laws, things like that I think can be really beneficial just to give you peace of mind and confidence. And again, dentistry, are maybe a bit more risk adverse because luckily we don't have patients dying That's great thing. Yeah, that's fantastic. I want my dentists to be risk adverse. I think so too. But Jason, I appreciate you being on the podcast today.   And for all of you listening, ⁓ more confidence, more clarity, more streamline to be able to serve and help our patients better. if we can help you in any way or you've got more questions, reach out Hello@TheDentalATeam.com. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.  

The JournalFeed podcast for the week of Dec 29, 2025 to Jan 2, 2026Monday's Spoon Feed:Implementing Spanish-language discharge instruction videos, interpreter-needed EMR icons, and standardized communication processes in a pediatric ED eliminated a 10% communication equity gap between Spanish- and English-speaking families without increasing length of stay or ED return visits.Tuesday's Spoon Feed:Similar to prior research on the topic, prehospital endotracheal intubation (ETI) is more successful with both sedative and paralytic than with no medications or sedative alone.Wednesday's Spoon Feed:The updated AHA and AAP guidelines on neonatal life support provide the most current, evidence-based recommendations for recognizing and managing newborns who require resuscitation, a time-critical responsibility that has a major impact on survival and neurodevelopmental outcomes.Thursday's Spoon Feed:Here are the top ten most viewed JournalFeed posts in 2025 (from our Google Analytics data). I've dropped a comment on how each article has impacted me this year. Enjoy!Friday's Spoon Feed:Bag valve mask (BVM) ventilations provided by Basic Life Support (BLS) teams during 30:2 cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) frequently fell well short of the guideline goals for expiratory tidal volume (Vte).

In this week's episode we've pulled a vault recording from 2025! Blood editor Dr. Laurie Sehn interviews authors Drs. David-Alexandre Trégouët and Johannes Schetelig on their research published in volume 146 issue 19 of Blood journal. Dr. Trégouët's study conducted a genome-wide association study supplemented by transcriptome and Mendelian randomization analyses to identify 28 loci and proteins associated with VTE recurrence risk. This work provides genomic evidence that inherited variants contribute to the risk of VTE recurrence, raising the possibility of a more personalized approach to the prevention of recurrent VTE. The study conducted by Dr. Schetelig and colleagues report the results of a long term trial on patients with poor-response AML, comparing outcomes between patients who received salvage chemotherapy versus immediate transplantation. With no difference in survival rates at 5 years, outcomes seem to be determined mainly by genetic risk factors, age, and comorbidities, therefore challenging the routine use of intensive remission induction before allogeneic transplant in patients with an available donor and underscore the need for novel therapeutic strategies for poor-risk AML.Featured Articles:Molecular Determinants of Thrombosis Recurrence Risk Across Venous Thromboembolism Subtypes Disease risk but not remission status determines transplant outcomes in AML: long-term outcomes of the ASAP trial 

During this episode, experts discuss quality improvement initiatives that utilize VTE risk assessment tools, treatment algorithms, and patient communication strategies to optimize care delivery and improve patient outcomes.   Claim CE and MOC Credit at https://bit.ly/3Mhkjda

Send us a textIn this episode of CLOT Conversations, co-hosts Dr. Jamil Abdul-Rahman and Dr. Maha Othman have an in-depth discussion with leading thrombosis expert Dr. Jeff Weitz. Together, they unpack new findings from The Lancet on RGN-9933 and RGN-7508, two investigational factor XI inhibitors evaluated in the ROXI-VTE I and II phase-2 trials. These studies examine how targeted inhibition of factor XI may reduce post-operative venous thromboembolism with potentially lower bleeding risk than current anticoagulants.Dr. Weitz explains the distinct mechanisms of the two antibodies, the role of factor XII-mediated activation in post-operative VTE, key efficacy and safety outcomes, and how these early-phase studies set the stage for ongoing phase-2 and phase-3 trials—including ROXI-CATH, ROXI-Aspirin, and emerging AF and stroke-prevention research.This episode is essential listening for clinicians interested in the rapidly evolving landscape of anticoagulation and next-generation therapies that may offer safer options for patients undergoing orthopedic surgery and beyond.Read the full Lancet publication by clicking on the link below and explore more thrombosis resources at thrombosiscanada.ca.Become a Thrombosis Champion, be a monthly donor at https://thrombosiscanada.ca/donatehttps://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02097-5/abstract [Note: full access requires a subscription]Support 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

Show notes at pharmacyjoe.com/episode1081. In this episode, I'll discuss anti-Xa monitoring of enoxaparin in VTE prophylaxis.

[✐3. Moderato] Implying a sense of gratitude for receiving actions [Vte ・くれます]“Maybe he/she will (kindly) take me to the moon!?”[00:08]Hello, how are you doing?When someone do something for you, we, Japanese, prefer to add the nuance of gratitude by saying “~てくれます”(kindly do … for me).[00:20]Please change the word into “~てくれます”[00:26]For example,make→ (kindly) make (for me)Ready?[00:32]1. write→ (kindly) write 2. explain→ (kindly) explain 3. teach/inform/let me know→ (kindly) teach4. help→ (kindly) help 5. lend→ (kindly) lend 6. search/look for→ (kindly) search 7. listen to the story/listen to me→ (kindly) listen to me (my story)8. call→ (kindly) call me (call for me)9. repair/fix→ (kindly) repair (for me)10. bring→ (kindly) bring (for me)[02:47]Now, listen to the key words [KW] and repeat the sentence.[02:51]1. [KW] my grandmother, sweets, make→ My   grandmother (kindly) often makes sweets.2. [KW]   my   grandfather, my bicycle, repair→ My grandfather (kindly) repairs my bicycle.3. [KW] porter, suitcase, carry→ The porter (kindly) carry my suitcase.4. [KW]   my   brother, my homework, help→ My brother always (kindly) helps me with my homework.5. [KW] Maria san, her baby's picture, showed→ Maria san (kindly) showed me a picture of her baby.6. [KW] hotel reservation, Simon san, did/made→ Simon san (kindly) made the hotel reservation (for me).7. [KW] piano, my mother, taught→ My mother (kindly) taught me the piano.=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=「つきにつれていってくれるかも!?」[00:08]みなさん、こんにちは。おげんきですか。When someone do something for you, Japanese  tend to add the nuance of gratitude by saying “~てくれます”(kindly do … for me).[00:20]まず、つぎのように｢〜てくれます[Vte +くれます]｣に かえてください。[00:26]たとえば、つくります→つくってくれますいいですか。[00:32]1. かきます→ かいてくれます2. せつめいします→ せつめいしてくれます3. おしえます→ おしえてくれます4. てつだいます→ てつだってくれます5. かします→ かしてくれます6. さがします→ さがしてくれます7. (わたしの)はなしを ききます→ はなしを きいてくれます8. でんわします→ でんわしてくれます9. なおします→ なおしてくれます10. もってきます→ もってきてくれます[02:47]では、キーワード[Key Words]をきいてから、ぶんをリピートしてください。[02:51]1. [KW] そぼ、おかし、つくります→ そぼは (わたしに)よく おかしをつくってくれます。2. [KW]そふ、じてんしゃ、なおします→ そふは (わたしの)じてんしゃを なおしてくれます。3. [KW] ポーター、(わたしの)スーツケース、はこびます→ ポーターは スーツケースをはこんでくれます。4. [KW] あに、(わたしの)しゅくだい、てつだいます→ あには、いつもわたしのしゅくだいをてだってくれます。5. [KW] マリアさん、あかちゃんのしゃしん、みせました→ マリアさんは、あかちゃんのしゃしんをみせてくれました。6. [KW] ホテルのよやく、サイモンさん、しました→ ホテルのよやくは、サイモンさんがしてくれました。7. [KW] ピアノ、はは、おしえました→ ピアノは ははが おしえてくれました。Support the show=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=*=Need more translation & transcript? Become a patron: More episodes with full translation and Japanese transcripts. Members-only podcast feed for your smartphone app. Japanese Swotter on PatreonNote: English translations might sound occasionally unnatural as English, as I try to preserve the structure and essence of the original Japanese.

A client was prescribed oral birth control to help manage symptoms of perimenopause. The medication caused a deep vein thrombosis (DVT), which then caused a pulmonary embolism (PE). Altogether this forms a potentially deadly phenomenon called venous thromboembolism (VTE). She survived, and she's fine. But here's the thing: her PE was just two weeks ago, and she wants to receive deep massage to her neck, back, and shoulders. Yikes, right? Or maybe not? Listen in for some key decision points about this question. Resources:  A Doctor's Note is Not Good Enough… and what is better: online self-paced continuing education course, available here. Massage & Bodywork magazine, “Helping Clients with Complex Conditions”, Jan/Feb 2023, available here.   Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.      About our Sponsors:   Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.                      Website: anatomytrains.com                        Email: info@anatomytrains.com             Facebook: facebook.com/AnatomyTrains                       Instagram: www.instagram.com/anatomytrainsofficial   YouTube: https://www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA     

Send us a textDiagnosing recurrent venous thromboembolism (VTE) remains one of the biggest clinical challenges in thrombosis medicine. In this episode, Dr. Vicky Mai and Dr. Grégoire Le Gal join us to discuss the international PREDICTORS study (JTH, 2025), which evaluated the performance of commonly used clinical decision rules (Wells and Geneva scores) in patients with suspected recurrent VTE. They share why symptoms can be misleading, how residual clots complicate imaging, and what their findings mean for the safe use of D-dimer and anticoagulation status in clinical practice.Reference:Mai, V., Martens, E. S., Righini, M., Schulman, S., Thiruganasambandamoorthy, V., Kahn, S. R., ... & Le Gal, G. (2025). Performance of clinical decision rules in patients presenting with suspected recurrent venous thromboembolism: a multicenter prospective cohort study. Journal of Thrombosis and Haemostasis.https://www.sciencedirect.com/science/article/abs/pii/S1538783625004088Support 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

Welcome to the Oncology Brothers podcast! In this episode we we deep into the complexities of venous thromboembolism (VTE) with Drs. Jennifer Vaughn and Nicolas Gallastegui Crestani from The Ohio State University. Join us as we explore real-life VTE scenarios, discussing both provoked and unprovoked events, treatment durations, and cancer-associated cases. We cover essential topics such as: •⁠  ⁠The workup for hypercoagulable states in young patients •⁠  ⁠Long-term anticoagulation strategies for high-risk individuals •⁠  ⁠The role of D-dimer and risk scores in decision-making •⁠  ⁠Management of anticoagulation in patients with cancer undergoing treatment •⁠  ⁠Rapid-fire scenarios including superficial vein thrombosis and portal vein thrombosis Whether you're a healthcare professional or simply interested in the latest in oncology and hematology, this episode is packed with valuable insights and practical guidance. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to like, subscribe, and tune in for more discussions on challenging cases, treatment algorithms, and expert insights in the field of oncology! #VTE #Anticoagulation #DOACs #Hematology #MedEd #OncologyBrothers #Thrombosis #Clots #DVT #PE

A bold trial in valvular heart disease, a CV prevention trial whose message is humility, VTE dogma challenged, more news on oral GLP-1 agonists, and a few public service announcements are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I DOUBLE-CHOICE: Minimalist Approach to TAVI May Be as Good as Standard of Care https://www.medscape.com/viewarticle/double-choice-minimalist-approach-tavi-may-be-good-standard-2025a1000pp7 Patient & Physician Perspectives on CV Risk https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.124.011837 II KP Vaccinate Trial KP Vaccinate Trial https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500208 IAMI trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057042 Increasing Flu Vaccinations in Patients With Chronic Disease https://jamanetwork.com/journals/jama/fullarticle/2824956 MI FREEE Trial https://www.nejm.org/doi/full/10.1056/NEJMsa1107913 III Hi PRO Trial Apixaban for Extended Treatment of VTE https://www.nejm.org/doi/full/10.1056/NEJMoa2509426 Recurrent VTE in Patients with Provoked VTE https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/226140 IV Oral GLP-1 Agonists ATTAIN 1 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2511774 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Join Professor Iain McInnes for the latest episode of Discussing RA on The Immune-Mediated Inflammatory Disease Forum. In this episode, he highlights two papers: risk of MACE, VTE, and malignancies in patients with RA or UC treated with filgotinib and frequency of reporting of MACE, MI, and stroke between JAKis and anti-TNFα.

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

In this week's episode we'll learn about persistent changes in immune profiles in patients who have had diffuse large B-cell lymphoma, or DLBCL, and other cancers; that plasminogen activation and plasmin activity do not appear to play a role in routine physiological prevention of venous thromboembolism, or VTE; and about a novel mechanism that makes hematological malignancies carrying epigenetic mutations susceptible to PARP inhibitors.Featured Articles:Large B-cell lymphoma imprints a dysfunctional immune phenotype that persists years after treatmentPlasminogen activation and plasmin activity are not required to prevent venous thrombosis/thromboembolismTransposable elements as novel therapeutic targets for PARPi-induced synthetic lethality in PcG-mutated blood cancer

Cesarean Delivery: Major Abdominal SurgeryWelcome back to The Critical Care Obstetrics Podcast with hosts Suzanne McMurtry Baird (Nursing Director) and Stephanie Martin (Medical Director) of Clinical Concepts in Obstetrics.In this episode, we explore why cesarean delivery is not just another routine procedure—but truly a major abdominal surgery. While C-section is the most common surgical procedure performed in U.S. hospitals, its seriousness is often overlooked because of its frequency. We discuss:Why 1 in 3 births by cesarean should not normalize the risksThe role of evidence-based practices: avoiding the first cesarean, neuraxial anesthesia, infection prevention, and family-centered careWhat makes it a major surgery: open abdomen, incision types, considerations in obese patients, and classical cesarean challengesSafety for mothers, babies, and support persons in the ORCommon complications including VTE, infection and sepsis, blood loss, injury to other organs, and the rising risk of placenta accreta spectrumWe also highlight our new lecture in the Postpartum Course covering PACU care and Enhanced Recovery After Cesarean, including RN qualifications, complication management, and communication essentials.

In this episode, we talk with Dr. Christina Shenvi about ARIA, a finding associated with an early stage Alzheimer's infusion that can impact stroke and VTE care. The MRI of choice per neuroradiology are the T2 weighted and flare images seen on most routine head MRIs. The gradient recall echo are best for bleed and microhemorrhage. These are all part of a routine MRI. I would note in the order that you are looking for ARIA. Supported by Eli Lilly and Company

Experts discuss effective communication strategies to empower patients of their options, set realistic expectations, and guide them towards informed decisions. Claim CE and MOC Credits at https://bit.ly/VTEComm

Send us a textIn this episode, our host Dr. Arjun Pandey (Internal Medicine Resident) interviews special guest Dr. Stefan Jevtic (Hematology Fellow) on hematologic conditions in pregnancy. They discuss the clinical presentation, investigations and management of thrombocytopenia, anemia, VTE and other hematologic conditions in pregnancy. Be sure to tune into www.cbcmadeeasy.com to reinforce your knowledge!Hosted by: Dr. Arjun Pandey (Internal Medicine Resident)Special Guest: Dr. Stefan Jevtic (Hematology Fellow)Produced by: Dr. Arjun Pandey and Dr. Zahra MeraliSupport the show

Who/When to Treat Clinically Suspect Arthralgia Thoughtful, Effective RA Care Should be Guided by Need —Not Age The Impact of Biologics on Methotrexate Adherence Jokes Aside: The Impact of Laughter in RA JAK Safety Update Why is RA Difficult to Treat? DMARD Combinations in RA Treatment Increased Risk of VTE in RA: Lessons Learned from 40 Years of Data ALTO: Long-term Outcomes of APIPPRA

Heart attacks & strokes are down, but guess what's rising? ⚡ Atrial fibrillation,

Deucravacitinib's Place in the PsA Treatment Algorithm? Lessons on Uveitis and AxSpA Difficult to Treat Axial Spondyloarthritis MRI Lesions in Early axSpA vs Non-axSpA JAK Safety Update Why is RA Difficult to Treat? DMARD Combinations in RA Treatment Increased Risk of VTE in RA: Lessons Learned from 40 Years of Data ALTO: Long-term Outcomes of APIPPRA

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 week, we kick off a new, highly-anticipated and highly-requested series, covering venous thromboembolism (VTE). In this first episode, we discuss how we make the initial diagnosis and how we approach initial management. As a clinician, you will undoubtedly come across the need to make this decision. This episode and this series will set you up for success!Episode contents:-What is venous thromboembolism?- How do we diagnose patients with VTE?- How do we initially management patients with VTE? - How do we select anticoagulants for VTE? ****This episode is sponsored by our Global Research Partners! Get paid to participate in market research surveys: https://affiliatepanel.members-only.online/FOC_24?utm_campaign=FOC&utm_source=email&utm_medium=email** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Concerned about VTE prevention in your facility? This episode explores how standardized protocols and technology can improve patient outcomes and operational efficiency. Join Dr. Parth Rali as he shares his experience at Temple University Hospital, including the creation of their Anticoagulation Stewardship Committee. You'll learn how standardizing care can lead to better decision-making and better results for patients. See References & Disclaimers.This episode is sponsored by Cardinal Health.

Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is responsible for 9–30% of pregnancy-related mortality in high resource countries and remains a significant, increasing cause of severe maternal morbidity. Peripartum, 50% of VTE events occur in the postpartum interval, which has a 6-fold higher risk compared to antepartum. There is wide variation in LMWH pharmacological postpartum prophylaxis guidance. The RCOG, for example, recommends 10 days of LMWH for all postop CS patients unless it was elective, and additional risk factors exist. The ACOG uses a more selective approach. However, on Jan 16, 2025, a new multicenter retrospective study from the US is raising questions about the efficacy of postpartum VTE pharmacologic therapy. Is there really no need for pp VTE pharmacologic therapy? Or does the answer lie in the reality of VTE as a “low frequency, high acuity” event? Listen in for details!