Podcasts about VTE

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

In this podcast accompanying the June issue of DTB, David Phizackerley (DTB Editor) is joined by Julian Treadwell (DTB Associate Editor) and Laurence Leaver (GP). David and Julian start by discussing the editorial - https://dtb.bmj.com/content/63/6/82 - which highlights some of the challenges in preventing VTE in early pregnancy. They also talk about a cohort study - https://dtb.bmj.com/content/63/6/84 - that assessed whether gabapentinoid use was associated with severe exacerbations among patients aged >55 years with chronic obstructive pulmonary disease (COPD). In the second half of the podcast, Julian talks to Laurence about two articles - https://dtb.bmj.com/content/63/5/74 and https://dtb.bmj.com/content/63/6/85 - he wrote on managing ADHD in adults.   Their discussion includes issues relating to diagnosis, effectiveness of medication, starting and titrating medication and some of the common adverse effects associated with medication. Both articles are currently free to access on the DTB website.   Please subscribe to the DTB podcast to get episodes automatically downloaded to your mobile device and computer. Also, please consider leaving us a review or a comment on the DTB Podcast iTunes podcast page. If you want to contact us please email dtb@bmj.com. Thank you for listening.

In this week's episode, we'll hear about new insights into PU.1-mutated agammaglobulinemia. Researchers show that haploinsufficiency of the master transcriptional regulator PU.1 causes agammaglobulinemia and dendritic cell deficiencies. These patients experience an array of infectious and non-infectious complications, but not leukemia. After that: venetoclax-based induction therapy in younger patients with AML. Venetoclax plus decitabine was associated with superior safety and non-inferior response rates compared to intensive chemotherapy. Is it time to consider lower-intensity therapy beyond older and unfit patients? Finally, a focus on venous thromboembolism. Researchers link BGAT, an enzyme pivotal to determining blood type, to risk of future VTE. They say high plasma levels of BGAT contribute to risk above and beyond what can be explained by von Willebrand factor and Factor VIII.Featured Articles:One hundred thirty-four germ line PU.1 variants and the agammaglobulinemic patients carrying themVenetoclax and decitabine vs intensive chemotherapy as induction for young patients with newly diagnosed AMLHisto–blood group ABO system transferase plasma levels and risk of future venous thromboembolism: the HUNT study

Vaginal oestrogen is safe at any age, including over 70, with regular review Use vaginal oestrogen cautiously in younger women; rule out other causes such like vulval dermatitis In breast cancer survivors, vaginal oestrogen is off-label; prefer estriol and involve oncology Vaginal DHEA (Intrarosa) is effective with minimal absorption; lacks long-term safety data; no washout needed when switching The questions answered in this podcast are listed below.They were compiled by GPs and health professionals around Australia who attended Healthed’s face-to-face seminars. What are the main symptoms for women with vaginal atrophy, and what is the general approach when a woman comes to talk about these symptoms? How long can women use vaginal oestrogen for? If you saw a woman over the age of 70, would you feel comfortable allowing her to continue using vaginal oestrogen? Is it safe to use vaginal oestrogen in a younger woman who might be breastfeeding or taking the combined oral contraceptive pill and experiencing vaginal dryness or discomfort? Do you need to take the same precautions for side effects as you would with systemic hormone therapy? For example, if there was a woman who was prone to venous thromboembolism (VTE), is it safe for her to use vaginal oestrogen? Is there any role for vaginal oestrogen in reducing the frequency of recurrent genital herpes outbreaks? Are there situations where you would use vaginal oestrogen in combination with a non-hormonal product for better results? Thoughts on laser treatments, microneedling, or PRP for vaginal or vulval symptoms? In women who present with urethral caruncles, is there a role for vaginal oestrogen as part of the treatment? How long would you try using vaginal oestrogen for that? What about the doses of oestrogen when treating someone who's had breast cancer? What do we have to be mindful of? What about women with a history of endometrial, cervical, or vulval cancer? Can we use vaginal oestrogen if they've got symptoms? Can DHEA (Intrarosa) be used safely in women with a history of cancer? For women without breast cancer, when would you use DHEA instead of oestrogen? Would you ever use both oestrogen and DHEA together? What about using DHEA in conjunction with systemic menopausal hormone therapy? Are there any thoughts around the improvements in libido with the use of DHEA? If you had tried someone on Ovestin (estriol) and wanted to switch to Intrarosa, is a washout period required before starting? Host: Dr Marita long | Total Time: 33 mins Expert: Dr Terri Foran, Sexual Health Physician Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEST Click here to register for the next oneSee omnystudio.com/listener for privacy information.

During this episode a panel of experts discuss the patient journey through the interpretation and application of safety and efficacy data to establish and maintain protocols designed to address optimal VTE treatment pathways. Claim CE and MOC Credit at bit.ly/VTEPJ6 

Join Professor Iain McInnes for the latest episode on The Immune-Mediated Inflammatory Disease Forum, where he discusses the latest updates in RA. In this episode, he discusses 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.

Send us a textIn this episode of CLOT Conversations, we sit down with Dr. Marc Carrier to explore a groundbreaking study published in the New England Journal of Medicine on reduced-dose apixaban for cancer-associated venous thromboembolism (VTE). Dr. Carrier breaks down the study's findings, which suggest that a lower dose of apixaban after six months of treatment is just as effective in preventing clot recurrence — and significantly safer in terms of bleeding risk. Tune in for expert insights on how this data could shift clinical practice and improve outcomes for patients living with cancer.Reference:Mahé I, Carrier M, Mayeur D, Chidiac J, Vicaut E, Falvo N, Sanchez O, Grange C, Monreal M, López-Núñez JJ, Otero-Candelera R. Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism. New England Journal of Medicine. 2025 Mar 29.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

Join us in this insightful episode of the Oncology Brothers podcast as we dive deep into the current treatment landscape of pancreatic cancer. Drs. Rohit and Rahul Gosain are joined by Dr. Emil Lou, a medical and neuro-oncologist from the University of Minnesota, to discuss the challenges and advancements in managing this complex disease. In this episode, we covered: •⁠  ⁠The importance of a multidisciplinary approach in treating early-stage pancreatic cancer. •⁠  ⁠The role of neoadjuvant and adjuvant therapies, including the latest insights on chemotherapy regimens like FOLFIRINOX, nal-IRI and gemcitabine. •⁠  ⁠The significance of germline and next-generation sequencing (NGS) testing in personalizing treatment plans. •⁠  ⁠The current state of clinical trials and emerging therapies, including PARP inhibitors for BRCA mutations and the implications of ctDNA testing. •⁠  ⁠Prognostic discussions around metastatic pancreatic cancer and the importance of managing side effects to improve patient quality of life. Key takeaways include the necessity of balancing treatment efficacy with adverse events, the critical role of genetic testing, and the need for vigilance regarding venous thromboembolism (VTE) in pancreatic cancer patients. Don't miss this comprehensive discussion that aims to shed light on the ongoing efforts to improve outcomes for patients battling pancreatic cancer.   YouTube: https://youtu.be/HCKQxmOqRTI   Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Subscribe to our channel for more discussions on oncology and stay updated on the latest in cancer treatment!

In this episode, a panel of experts discuss existing and emerging VTE (venous thromboembolism) treatment options for the complex patient, such as a patient who has been diagnosed with cancer, end stage renal disease (ESRD), chronic kidney disease (CKD), or is obese.  Claim CE and MOC Credit at https://bit.ly/VTEHBCPX

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

Antithrombotic Therapy in VTE

  The RENOVE trial compared reduced-dose versus full-dose DOACs for extended venous thromboembolism VTE treatment in high-risk patients. While the reduced dose cut major bleeding risk by 39%

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.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/patient-case-study-obesity-and-vte/32305/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/implications-associated-with-integrating-both-real-world-data-and-clinical-trial-data-into-clinical-practice-af-considerations/32298/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/how-do-we-translate-real-world-af-data-into-everyday-clinical-practice/32299/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/patient-case-study-elderly/32300/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/af-and-vte-global-considerations-in-the-evolving-space-of-real-world-data/32304/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/patient-case-study-obesity/32301/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/implications-associated-with-integrating-both-real-world-data-and-clinical-trial-data-into-clinical-practice-vte-considerations/32302/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/how-do-we-translate-real-world-vte-data-into-everyday-clinical-practice-for-ongoing-anticoagulation/32303/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/trade-off-ischemicthrombotic-vs-bleeding/32297/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

CME credits: 1.00 Valid until: 14-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/setting-the-stage-of-real-world-data-vs-rct/32296/ The effective management of atrial fibrillation (AF) remains a high priority for many clinicians worldwide because a significant number of people globally who are living with AF are at risk of developing venous thromboembolism (VTE). This makes our understanding and implementation of new findings and clinical trial outcomes that much more important as we develop effective, personalized treatment plans for our patients. Tune in to our micro learning course to make sure you're up to date and providing the care your patients deserve.

Venous Thromboembolism (VTE) is a condition where blood clots form in a blood vessel. As serious as heart attacks and strokes, VTE is the most common cause of preventable death in hospitalized patients. Interventional Radiologist Scott Perrin, MD, discusses the dangers of the disease and what can be done to treat deep vein thrombosis (DVT) and pulmonary embolism (PE).You can also watch the video recording on our Vimeo channel here.For more health tips & news you can use from experts you trust, sign up for Sarasota Memorial's monthly digital newsletter, Healthe-Matters.

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!

This week we discuss blood clots A blood clot is a clump of blood that has changed from a liquid to a gel-like or semisolid state. Clotting is a necessary process that can help prevent excessive blood loss when you have a cut, for example. Thrombosis is when a blood clot forms and reduces blood flow. There are two types: Arterial thrombosis occurs when a blood clot forms in an artery. Venous thrombosis occurs when a blood clot forms in a vein. When a clot forms inside one of your veins, it may dissolve on its own. However, sometimes a clot doesn't dissolve on its own, or part of it breaks off and travels elsewhere in your circulatory system. When this happens, the blood clot may get stuck elsewhere and restrict blood flow, known as embolism. These situations can be very dangerous and even life threatening. According to the Centers for Disease Control and Prevention (CDC), 1 in 2 people don't experience any symptoms when they have a deep venous blood clot. When symptoms do appear, it's important to get immediate medical attention. ​ Medical emergency A blood clot may be a medical emergency and life threatening if left untreated. Call 911 or go to the nearest emergency room immediately if you or someone you're with experiences symptoms of a serious blood clot, such as: sudden shortness of breath chest pressure difficulty breathing, seeing, or speaking ​Call a doctor or seek medical attention if you experience throbbing, swelling, and tenderness in one body part.  

Case Discussion 120: VTE prophylaxis

Dr Tony Wan shares the results of a study that examined the effectiveness of an anticoagulation stewardship program (ACSP) in improving adherence to venous thromboembolism (VTE) prophylaxis guidelines and reducing costs at a Canadian teaching hospital. Here what he has to say about the results and the process of setting up the study in his hospital.Tony Wan, Stephanie J. Garland, Chipman Taylor Drury, Justin Lambert, Joshua Yoon, Melissa Chan, Anticoagulation stewardship: Improving adherence to clinical guidelines and reducing overuse of venous thromboembolism prophylaxis in hospitalized medical patients, Thrombosis Research, Volume 239, 2024, https://www.sciencedirect.com/science/article/pii/S0049384824001622 Donate to Thrombosis Canada: https://thrombosiscanada.ca/donateSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Welcome to Ask Stago, The Podcast dedicated to provide expert answers to your expert questions in coagulation. In today's episode, our guest Dr. Refaai  will help us understand the formation and function of fibrin monomers (FM) in hemostasis, highlighting their crucial role in coagulation and clot formation and the need for more prospective studies to validate this assay for clinical indications such as DIC, VTE and cancer. Literature sources: Refaai M.A. (2018) The Clinical Significance of Fibrin Monomers. Thromb Haemost, 118, 1856. Content is scientific and technical in nature. It is intended as an educational tool for laboratory professionals and topics discussed are not intended as recommendations or as commentary on appropriate clinical practice.

Pulmonary emboli in Trauma patients is, unfortunately, an established and not uncommon complication we must deal with. Today, we welcome one of our own Trauma Surgeons, Dr Brent Emigh, MD to the Podcast to discuss VTE occurance and prophylaxis in Trauma patients. Article with more information on PE in Trauma patients is HERE Article mentioned on IVC filters can be accessed HERE If anyone has comments on this episode or suggestions for topics please feel free to reach out to me at kenneth_lynch@brown.edu

Vteřiny, minuty, hodiny, dny, týdny… Čas měřily už prastaré civilizace a vytvářely velmi důmyslné kalendáře, příkladem budiž třeba Mayové nebo Aztékové. Znamená čas všude na světě totéž? Martin Rychlík a Martin Soukup promluví o tom, že lidé se liší i v tom, jak se k času a jeho měření vztahují. Některé kultury totiž slovo „čas“ vůbec neznají. Čím bylo třeba pro původní obyvatele Austrálie důležité mytické bezčasí? Kde zítra znamená až pozítří? A co je to tyranie okamžiku?

Everyone understands that VTE (DVT and/or VTE) requires life-saving anticoagulation. That's simple. No controversy there. But what about pregnancy-associated superficial thrombophlebitis (AKA superficial venous thrombosis) in an extremity? Does that need anticoagulation? We have been traditionally taught that superficial venous issues are benign and do not require LMWH. Is that correct? The answer is NOT as straightforward as you would think. In this episode, we will review the 2018 ASH guidelines and contrast them to the 2022 published consensus statement from the Balkan Working Group. Plus, we will highlight a May 2023 Danish population based study from the Lancet Hematology that reminds us that superficial venous disease is not always benign in its course. Listen in for details,

Vladimír Mišík se na svém novém albu Vteřiny, měsíce a roky potkává se synem Adamem. „Adam zpívá jinou hudbu, má jiný styl přednesu, jako je to jiný člověk, ale ta barva hlasu je úplně stejná. Tak jsem si říkal, že to musíme využít,“ popisuje producent Petr Ostrouchov kouzlo, které zafungovalo už na předchozích deskách. Jak se skládá hudba pro stárnoucího rockera? „Hraní postaru umožňuje, aby ti hráči jednotlivě na sebe reagovali, ovlivňovali se,“ vysvětluje.Všechny díly podcastu Host Radiožurnálu můžete pohodlně poslouchat v mobilní aplikaci mujRozhlas pro Android a iOS nebo na webu mujRozhlas.cz.

Vladimír Mišík se na svém novém albu Vteřiny, měsíce a roky potkává se synem Adamem. „Adam zpívá jinou hudbu, má jiný styl přednesu, jako je to jiný člověk, ale ta barva hlasu je úplně stejná. Tak jsem si říkal, že to musíme využít,“ popisuje producent Petr Ostrouchov kouzlo, které zafungovalo už na předchozích deskách. Jak se skládá hudba pro stárnoucího rockera? „Hraní postaru umožňuje, aby ti hráči jednotlivě na sebe reagovali, ovlivňovali se,“ vysvětluje.

Je producentem posledních tří desek Vladimíra Mišíka. Včetně té poslední Vteřiny, měsíce a roky. „Neřekli jsme si, čím se budou lišit. Dělali jsme je, jak jsme chtěli.“ Kdy a jak začal s hudbou? Je Michael Žantovský dobrý textař? Ke kterým filmům složil hudbu? Jak moc je v českých písničkách důležitý text? Dělá rád písničky tzv. na tělo?Všechny díly podcastu Blízká setkání můžete pohodlně poslouchat v mobilní aplikaci mujRozhlas pro Android a iOS nebo na webu mujRozhlas.cz.

Proč se po soudních zaměstnancích rozhodli stávkovat i pražští zaměstnanci státních zastupitelstvích? Jak budou fungovat italská migrační centra v Albánii? Přispějí k řešení problému migrace do Evropy? A o čem jsou básně a hudba na novém studiovém albu Vladimíra Mišíka Vteřiny, měsíce a roky?

Vladimír Mišík vydává své nejnovější album Vteřiny, měsíce a roky, na kterém opět spolupracoval s Petrem Ostrouchovem. „Točilo se takovým jamujícím způsobem. Je to muzikantsky skvělé,“ pochvaluje si. Přiznává, že svého času žil život svižně, rychle, ale kvůli zdraví musel zpomalit. „To tempo se nedá udržovat. Zpomalil jsem a bohužel jsem se musel vzdát i koncertování, protože už to nešlo.“ Jak vzpomíná na kytaristu Radima Hladíka?Všechny díly podcastu Host Lucie Výborné můžete pohodlně poslouchat v mobilní aplikaci mujRozhlas pro Android a iOS nebo na webu mujRozhlas.cz.

In this episode, we talk with Dr. Frank Peacock and Dr. Jame Neuenschwander about the current statue of VTE, DVT, PE, and AFib management, as well as the approach to anticoagulation reversal. Great podcast on a common EM presentation and opportunities in EM. ACEP POC Tools - https://poctools.acep.org/

IntroductionWelcome to PICU Doc On Call, a podcast dedicated to current and aspiring pediatric intensivists. I'm Dr. Pradip Kamat from Children's Healthcare of Atlanta/Emory University School of Medicine, and I'm Dr. Rahul Damania from Cleveland Clinic Children's Hospital. We are two Pediatric ICU physicians passionate about medical education in the PICU. This podcast focuses on interesting PICU cases and their management in the acute care pediatric setting.Episode OverviewIn today's episode, we are excited to welcome Dr. Karen Zimowski, Assistant Professor of Pediatrics at Emory University School of Medicine and a practicing pediatric hematologist at Children's Healthcare of Atlanta at the Aflac Blood & Cancer Center. Dr. Zimowski specializes in pediatric bleeding and clotting disorders.Case PresentationA 16-year-old female with a complex medical history, including autoimmune thyroiditis and prior cerebral infarcts, was admitted to the PICU with acute chest pain and difficulty breathing. Despite being on low-dose aspirin, her oxygen saturation was 86% on room air. A CT angiography revealed a pulmonary embolism (PE) in the left lower lobe and signs of right heart strain. The patient was hemodynamically stable, and thrombolytic therapy was deferred in favor of anticoagulation. She was placed on BiPAP to improve her respiratory status. Her social history was negative for smoking, illicit drug use, or oral contraceptive use.Key Case PointsDiagnosis: Pulmonary embolism (PE)Hemodynamics: Stable with no right ventricular (RV) strain on echocardiogramManagement Focus: Anticoagulation and consultation with the hematology/thrombosis teamExpert Discussion with Dr. Karen ZimowskiRisk Factors and Epidemiology of VTE in PediatricsPathophysiology: Venous thromboembolism (VTE) in children involves components of Virchow's triad: stasis of blood flow, endothelial injury, and hypercoagulability.Incidence: VTE is rare in the general pediatric population but increases significantly in hospitalized children.Age Distribution: Bimodal peaks in infants and adolescents aged 15-17 years.Risk Factors: Central venous lines, infections, congenital heart disease, cancer, and autoimmune disorders.Clinical Manifestations of DVTSymptoms: Swelling, pain, warmth, and skin discoloration in the affected extremity.Specific Presentations:SVC syndrome from superior vena cava thrombosisAbdominal pain from portal vein thrombosisHematuria from renal vein thrombosisNeurological symptoms...

CHEST August 2024, Volume 166, Issue 2 CHEST® journal's Editor in Chief, Peter Mazzone, MD, MPH, FCCP, highlights key research published in the journal CHEST August 2024 issue, including a study into the incidence of nontuberculous mycobacterial diseases among adults in Denmark, research into barriers and facilitators for surrogates providing consent for critically ill patients, and a compendium of CHEST organization guidelines on antithrombotic therapy for VTE.

In this week's episode we'll discuss minimal residual disease as an intermediate clinical endpoint for multiple myeloma. Then, we'll learn about IPSS-R downstaging before transplant in MDS. Finally we'll hear about the connection between hereditary angioedema and venous thromboembolism. Featured Articles:EVIDENCE meta-analysis: evaluating minimal residual disease as an intermediate clinical endpoint for multiple myeloma Does IPSS-R down-staging before transplantation improve the prognosis of patients with Myelodysplastic Neoplasms? Increased risk of venous thromboembolism [or VTE] in young and middle-aged individuals with hereditary angioedema: a family study

New updates to the VTE guidelines empower nurses to take a more proactive role in preventing Venous Thromboembolism (VTE) or blood clots. This includes the ability to initiate preventive measures, such as applying compression stockings or using inflatable leg sleeves, at an earlier stage when a patient is suspected to be at high risk.The revised guidelines emphasize the crucial role of thorough risk assessment. Nurses should not only evaluate a patient's susceptibility to VTE formation but also consider their risk of bleeding complications. To ensure effective implementation, the guidelines come with a comprehensive toolkit for nurses. These tools include resources for risk assessment and selecting the most suitable preventative measures for each individual patient.The updated guidelines also recognize the significant contribution of perioperative nurses in preventing VTE. These nurses can play a vital role by educating patients about the importance of early mobilization after surgery. Encouraging patients to involve their families in the recovery process can further enhance successful outcomes.Support the Show.Welcome to the Periop Talk—your go-to vlog and podcast series where we examine the world of perioperative nursing.Episode after episode, we're bringing you professional tips, clinical wisdom, and personal stories that'll make you feel like you're chatting with your work BFFs. Curious about the latest surgical techniques? We got you. Wondering how to navigate the challenges of the periop journey? We're here for that too.Our vlog and podcast series isn't just about sharing information; it's about building a community. Meet the people behind the masks, hear their journeys, and join the rotation of periop professionals making a difference. From students and new nurses to seasoned pros, we've got content for every stage of your perioperative practice.Periop Talk is your peek behind the red line to the world of perioperative nursing. It's not just about the OR – it's about the heart and soul of healthcare. Let's scrub in and share the periop love!Watch us at: (1) Periop Talk vlog - YouTube

VTE prophylaxis is more than just some squeezy leg socks and a one-size fits all dose of enoxaparin!  Ever wonder how VTE prophylaxis is similar to constipation?  Have you or a loved one been hurt by a hospital administrator telling you that VTE is a never event?  Come with us, and our special guest Dr. Bryan Cotton, on this journey to the frontier of research attempting to debunk this myth and improve patient care by reducing VTE rates in trauma patients.   Hosts: - Michael Cobler-Lichter, MD, PGY4/R2: University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @mdcobler (X/twitter) - Eva Urrechaga, MD, PGY-8, Vascular Surgery Fellow University of Pennsylvania Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center General Surgery Residency @urrechisme (X/twitter) - Eugenia Kwon, MD, Trauma/Surgical Critical Care Attending: Loma Linda University Recent graduate of University of Miami/Jackson Memorial Hospital/Ryder Trauma Center Trauma/CC Fellowship - Brandon Parker, DO, Assistant Professor of Surgery, 5 years in practice University of Miami/Jackson Memorial Hospital/Ryder Trauma Center @BrandonParkerDO (X/twitter) - Bryan Cotton, MD, MPH, FACS, Professor of Surgery, 20 years in practice  University of Texas Health Science Center at Houston/Red Duke Trauma Institute at Memorial Herman Hospital @bryanacotton1 (X/twitter) Learning Objectives: - Describe the rationale for the addition of aspirin to chemoprophylactic regimens for VTE -  Identify appropriate screening systems for trauma patients at high risk for VTE -  Describe the rationale for monitoring anti factor Xa levels in the trauma population receiving VTE chemoprophylaxis - List the major conclusions of the two studies discussed regarding the addition of aspirin to VTE chemoprophylaxis regimens in trauma patients, and the change in antithrombin activity levels over time in relation to enoxaparin responsiveness in polytrauma patients Quick Hits: 1.     On adjusted analysis, the standard VTE PPX plus aspirin group had a lower OR of developing VTE, though limitations of this study highlight need for future prospective work 2.     Trauma patients often suffer from decreased activity of antithrombin 3, which may mediate the relatively higher rates of VTE in this population. 3.     Trauma patients who went on to develop VTE were more likely to not achieve satisfactory anti Xa levels, with a VTE rate of 30% in the never-responder group, the group for which Xa levels were never higher than 0.2 4.     Ex vivo supplementation of antithrombin seems to improve enoxaparin responsiveness.  Remember, enoxaparin and heparin are HELPING AT3, not the other way around References 1.     Lammers D, Scerbo M, Davidson A, et al. Addition of aspirin to venous thromboembolism chemoprophylaxis safely decreases venous thromboembolism rates in trauma patients. Trauma Surg Acute Care Open. 2023;8(1):e001140. doi:10.1136/tsaco-2023-001140 https://pubmed.ncbi.nlm.nih.gov/37936904/ 2.     Vincent LE, Talanker MM, Butler DD, et al. Association of Changes in Antithrombin Activity Over Time With Responsiveness to Enoxaparin Prophylaxis and Risk of Trauma-Related Venous Thromboembolism. JAMA Surg. 2022;157(8):713-721. doi:10.1001/jamasurg.2022.2214 https://pubmed.ncbi.nlm.nih.gov/35731524/ Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen

Drs. Vamsi Velcheti and Nathan Pennell discuss novel approaches and key studies in lung cancer that were showcased at the 2024 ASCO Annual Meeting, including the Plenary abstracts LAURA and ADRIATIC.   TRANSCRIPT Dr. Vamsi Velcheti: Hello, I am Dr. Vamsi Velcheti, your guest host for the ASCO Daily News Podcast today. I'm a professor of medicine and director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Health. Today, I'm joined by Dr. Nate Pennell, the co-director of the Cleveland Clinic Lung Cancer Program and the vice chair of clinical research at the Taussig Cancer Center in Cleveland Clinic. Dr. Pennell is also the editor-in-chief of the ASCO Educational Book. Today, we will be discussing practice-changing abstracts and the exciting advances in lung cancer that were featured at the ASCO 2024 Annual Meeting. You'll find our full disclosures in the transcript of the episode. Nate, we're delighted to have you back on the podcast today. Thanks for being here. It was an exciting Annual Meeting with a lot of important updates in lung cancer. Dr. Nate Pennell: Thanks, Vamsi. I'm glad to be back. And yes, it was a huge year for lung. So I'm glad that we got a chance to discuss all of these late-breaking abstracts that we didn't get to talk about during the prelim podcast. Dr. Vamsi Velcheti: Let's dive in. Nate, it was wonderful to see all the exciting data, and one of the abstracts in the Plenary Session caught my attention, LBA3. In this study, the investigators did a comparative large-scale effectiveness trial of early palliative care delivered via telehealth versus in-person among patients with advanced non-small cell lung cancer. And the study is very promising. Could you tell us a little bit more about the study and your take-home messages? Dr. Nate Pennell: Yes, I think this was a very important study. So just to put things in perspective, it's now been more than a decade since Dr. Jennifer Temel and her group at Massachusetts General Hospital did a randomized study that showed that early interventions with palliative medicine consultation in patients with advanced non-small cell lung cancer significantly improves quality of life and in her initial study, perhaps even overall survival. And since then, there have been numerous studies that have basically reproduced this effect, showing that getting palliative medicine involved in people with advanced cancer, multiple different cancer types, really, has benefits.  The difficulty in applying this has been that palliative care-trained specialists are few and far between, and many people simply don't have easy access to palliative medicine-trained physicians and providers. So with that in mind, Dr. Temel and her group designed a randomized study called the REACH PC trial, where 1,250 patients were randomized with advanced non-small cell lung cancer to either in-person palliative medicine visits which is sort of the standard, or one in-person assessment followed by monthly telemedicine video visits with palliative medicine. Primary endpoint was essentially to show that it was equivalent in terms of quality of life and patient satisfaction. And what was exciting about this was that it absolutely was. I mean, pretty much across the board in all the metrics that were measured, the quality-of-life, the patient satisfaction, the anxiety and depression scores, all were equivalent between doing telemedicine visits and in-person visits. And this hopefully will now extend the ability to get this kind of benefit to a much larger group of people who don't have to geographically be located near a palliative medicine program. Dr. Vamsi Velcheti: Yeah, I think it's a great abstract, Nate and I actually was very impressed by the ASCO committee for selecting this for the Plenary. We typically don't see supportive care studies highlighted in such a way at ASCO. This really highlights the need for true interdisciplinary care for our patients. And as you said, this study will clearly address that unmet need in terms of providing access to palliative care for a lot of patients who otherwise wouldn't have access. I'm really glad to see those results. Dr. Nate Pennell: It was. And that really went along with Dr. Schuchter's theme this year of bringing care to patients incorporating supportive care. So I agree with you.  Now, moving to some of the other exciting abstracts in the Plenary Session. So we were talking about how this was a big year for lung cancer. There were actually 3 lung cancer studies in the Plenary Session at the Annual Meeting. And let's move on to the second one, LBA4, the LAURA study. This was the first phase 3 study to assess osimertinib, an EGFR tyrosine kinase inhibitor, in patients with EGFR mutant, unresectable stage III non-small cell lung cancer. What are your takeaways from this study?  Dr. Vamsi Velcheti: This is certainly an exciting study, and all of us in the lung community have been kind of eagerly awaiting the results of the study. As you know, for stage III non-small cell lung cancer patients who are unresectable, the standard of care has been really established by the PACIFIC study with the consolidation durvalumab after definitive concurrent chemoradiation. The problem with that study is it doesn't really answer the question of the role of immunotherapy in patients who are never-smokers, and especially in patients who are EGFR positive tumors, where the role of immunotherapy in a metastatic setting has always been questioned. And in fact, there have been several studies as you know, in patients with EGFR mutation positive metastatic lung cancer where immunotherapy has not been that effective. In fact, in the subgroup analysis in the PACIFIC study, patients with EGFR mutation did not really benefit from adding immunotherapy.  So this is an interesting study where they looked at patients with locally advanced, unresectable stage III patients and they randomized the patients 2:1 to osimertinib versus placebo following concurrent or sequential tumor radiation. The primary endpoint for the study was progression free survival, and a total of 216 patients were enrolled and 143 patients received a study treatment, which is osimertinib, and 73 received placebo. And 80% of the patients on the placebo arm crossed over to getting treatment at the time of progression.  So most of us in the lung cancer community were kind of suspecting this would be a positive trial for PFS. But however, I think the magnitude of the difference was truly remarkable. The median PFS in the osimertinib arm was 39.1 months and placebo was 5.6 months and the hazard ratio of 0.16. So it was a pretty striking difference in terms of DFS benefit with the osimertinib consolidation following chemoradiation. So it was truly a positive study for the primary endpoint and the benefit was seen across all the subgroups and the safety was no unexpected safety signals other than a slight increase in the radiation pneumonitis rates in patients receiving osimertinib and other GI and skin tox were kind of as expected. In my opinion, it's truly practice changing and I think patients with EGFR mutation should not be getting immunotherapy consolidation post chemoradiation. Dr. Nate Pennell: I completely agree with you. I think that this really just continues the understanding of the use of osimertinib in EGFR-mutant lung cancer in earlier stages of disease. We know from the ADAURA trial, presented twice in the Plenary at the ASCO Annual Meeting, that for IB, stage II and resectable IIIA, that you prolong progression free or disease free survival. So this is a very similar, comparable situation, but at an even higher risk population or the unresectable stage III patients. I think that the most discussion about this was the fact that the osimertinib is indefinite and that it is distinct from the adjuvant setting where it's being given for three years and then stopped. But I think all of us had some pause when we saw that after three years, especially in the stage III patients from ADAURA, that there were clearly an increase in recurrences after stopping the drug, suggesting that there are patients who are not cured with a time limited treatment, or at least with 3 years of treatment.  The other thing that is sobering from the study, and was pointed out by the discussant, Dr. Lecia Sequist, is if you look at the two-year disease-free survival in the placebo arm, it was only 13%, meaning almost no one was really cured with chemo radiation alone. And that really suggests that this is not that different from a very early stage IV population where indefinite treatment really is the standard of care. I wonder whether you think that's a reasonable approach. Dr. Vamsi Velcheti: I completely agree with you, Nate, and I don't think we cure a majority of our patients with stage III, and less so in patients who have EGFR-mutant, stage III locally advanced. As you just pointed out, I think very few patients actually make it that far along. And I think there's a very high rate of CNS micrometastatic disease or just systemic micrometastatic disease in this population that an effective systemic therapy of osimertinib can potentially have long term outcomes. But again, we perhaps don't cure a vast majority of them. I think that the next wave of studies should incorporate ctDNA and MRD-based assays to potentially identify those patients who could potentially go off osimertinib at some point. But, again, outside of a trial, I would not be doing that. But I think it's definitely an important question to ask to identify de-escalation strategies with osimertinib. And even immunotherapy for that matter, I think we all know that not all patients really require years and years of immunotherapy. They're still trying to figure out how to use immunotherapy in these post-surgical settings, using the MRD to de-escalate adjuvant therapies. So I think we have to have some sort of strategy here. But outside of a clinical trial, I will not be using those assays here to cite treatments, but certainly an important question to ask.  Moving on to the other exciting late-breaking abstracts, LBA5, the ADRIATIC study. This is another study which was also in the plenary session. This study was designed to address this question of consolidation immunotherapy, post chemo radiation for limited-stage small cell cancer, the treatment arms being durvalumab tremelimumab, and durvalumab observation. So what do you think about the study? This study also received a lot of applause and a lot of attention at the ASCO meeting. Dr. Nate Pennell: It was. It was remarkable to be there and actually watch this study as well as the LAURA study live, because when the disease free survival curves and in the ADRIATIC study, the overall survival curves were shown, the speakers were both interrupted by standing ovation of applause just because there was a recognition that the treatment was changing kind of before our eyes. I thought that was really neat. So in this case, I think this is truly a historic study, not necessarily because it's going to necessarily be an earth shakingly positive study. I mean, it was clearly a positive study, but more simply because of the disease in which it was done, and that is limited-stage small cell lung cancer. We really have not had a change in the way we've treated limited-stage small cell lung cancer, probably 25 years. Maybe the last significant advances in that were the advent of concurrent chemotherapy and radiation and then the use of PCI with a very modest improvement in survival. Both of those, I would say, are still relatively modest advances.  In this case, the addition of immunotherapy, which we know helps patients with small cell lung cancer - it's of course the standard of care in combination chemotherapy for extensive stage small cell lung cancer - in this case, patients who completed concurrent chemo radiation were then randomized to either placebo or durvalumab, as well as the third arm of durvalumab tremelimumab, which is not yet been recorded, and co primary endpoints were overall survival and progression free survival. And extraordinarily, there was an improvement in overall survival seen at the first analysis, with a median overall survival of 55.9 months compared to 33.4 months, hazard ratio of 0.73. So highly clinically and statistically significant, that translates at three years to a difference in overall survival of 56.5%, compared to 47.6%, or almost 10% improvement in survival at three years.  There was also a nearly identical improvement in progression-free survival, also with a hazard ratio of 0.76, suggesting that there's a modest number of patients who benefit. But it seems to be a clear improvement with the curves plateauing out. In my opinion, this is very comparable to what we saw with the PACIFIC study in stage III, unresectable non-small cell lung cancer, which immediately changed practice back when that first was reported. And I expect that this will change practice pretty much immediately for small cell as well. Dr. Vamsi Velcheti: Yeah, I completely agree, Nate. I think it's an exciting advance in patients with limited-stage small cell lung cancer. For sure, it's practice-changing, and I think the results were exciting.  So one thing that really intrigued me was in the extensive-stage setting, the benefit was very mediocre with one-to-two month overall survival benefit in both the PACIFIC and in IMpower trial. Here we are seeing almost two-year of median OS benefit. I was kind of puzzled by that, and I thought it may have to do with patients receiving radiation. And we've seen that with the PACIFIC, and makes you wonder if both the CASPIAN and the IMpower studies actually did not allow consolidation thoracic radiation. Hypothetically, if they had allowed consolidation thoracic radiation, perhaps we would have seen better outcomes. Any thoughts on that? Dr. Nate Pennell: We've been trying to prove that radiation and immunotherapy somehow go together better for a long time. Going back to the first description of the abscopal effect, and I'm not sure if I necessarily believe that to be the case, but in this setting where we truly are trying to cure people rather than merely prolong their survival, maybe this is the situation where it truly is more beneficial. I think what we're seeing is something very similar to what we're seen in PACIFIC, where in the stage IV setting, some people have long term survival with immunotherapy, but it's relatively modest. But perhaps in the curative setting, you're seeing more of an impact. Certainly, looking at these curves, we'll have to see with another couple of years to follow up. But a three-year survival of 56% is pretty extraordinary, and I look forward to seeing if this really maintains over the next couple of years follow up.  Moving beyond the Plenary, there were actually lots of really exciting presentations, even outside the Plenary section. One that I think probably got at least as much attention as the ones that we've already discussed today was actually an update of an old trial that's been presented for several prior years. And I'm curious to get your take on why you thought this was such a remarkable study. And we're talking about the LBA8503, which was the 5-year update from the CROWN study, which looked at previously untreated ALK-positive advanced non-small cell in cancer patients randomly assigned to lorlatinib, the third generation ALK inhibitor, versus crizotinib, the first generation ALK inhibitor. What was so exciting about this study, and why were people talking about it?  Dr. Vamsi Velcheti: Yeah, I agree, Nate. We've seen the data in the past, right? Like on the CROWN data, just first like a quick recap. This is the CROWN study, like the phase 3 study of third generation ALK inhibitor lorlatinib. So global randomized phase 3 study in patients with metastatic disease randomized to lorlatinib versus crizotinib, which is a controller. So the primary endpoint was PFS, and we've seen the results in the past of the CROWN readout quoted, with a positive study and the lorlatinib received FDA approval in the frontline setting. But the current study that was presented at the ASCO annual meeting is a kind of a postdoc analysis of five years. The endpoint for the study with central review stopped at three years, and this is actually a follow up beyond that last readout. Interestingly, in this study, when they looked at the median PFS at five years, the lorlatinib arm did not reach a median PFS even at five years and the hazard ratio is 0.19, which is kind of phenomenal in some ways. At 5 years, the majority of the patients were still on the drug. So that's quite incredible. And the benefit was more profound in patients with brain mets with a hazard ratio of 0.08. And again, speaking to the importance of brain penetrant, small molecule inhibitors, and target therapy, the safety profile, there were no additional safety signals noted in the study. We kind of know about the side effects of lorlatinib already from previous studies readouts. No unusual long-term toxicities.  I should note though, about 40% of patients did have CNS, AEs grade 1, 2 CNS toxicities on the  lorlatinib arm. And the other interesting thing that was also reported in the trial was dose reduction of lorlatinib did not have an impact on the PFS, which is interesting in my opinion. They also did some subgroup analysis, biomarker testing, biomarker populations. Patients who had P53 cooperation did much better with lorlatinib versus crizotinib. So overall, the other thing that they also had shown on the trial was the resistance mechanisms that were seen with lorlatinib were very different than what we are used to seeing with the earlier generation ALK inhibitors. The majority of the patients who develop resistance have bypass mechanisms and alterations in MAP kinase pathway PI3K/MTOR/PTEN pathway, suggesting that lorlatinib is a very potent ALK inhibitor and on target ALK mutations don't happen as frequently as we see with the earlier generation ALK inhibitors.  So I think this really begs the question, should we offer lorlatinib to all our patients with metastatic ALK-positive tumors? I think looking at the long-term data, it's quite tempting to say ‘yes', but I think at the same time we have to take into consideration patient safety tolerability. And again, the competitor arm here is crizotinib. So lorlatinib suddenly seems to be, again, cross trial comparisons, but I think the long-term outcomes here are really phenomenal. But at the same time, I think we've got to kind of think about patient because these patients are on these drugs for years, they have to live with all the toxicities. And I think the patient preferences and safety profile matters in terms of what drug we recommend to patients. Dr. Nate Pennell: I completely agree with you. I think the right answer, is that this has to be an individual discussion with patients. The results are incredibly exciting. I mean, the two-year progression free survival was 70%, and the five-year, three years later is still 60%. Only 10% of people are failing over the subsequent three years. And the line is pretty flat. And as you said, even with brain metastases, the median survival is in reach. It's really extraordinary. Moreover, while we do talk about the significant toxicities of lorlatinib, I thought it was really interesting that only 5% of people were supposedly discontinued the drug because of treatment related AEs, which meant that with dose reduction and management, it seems as though most patients were able to continue on the drug, even though they, as you mentioned, were taking it for several years.  That being said, all of us who've had experience with the second-generation drugs like alectinib and brigatinib, compared to the third-generation drug lorlatinib, can speak to the challenges of some of the unique toxicities that go along with it. I don't think this is going to be a drug for everyone, but I do think it is now worth bringing it up and discussing it with the patients most of the time now. And I do think that there will be many people for whom this is going to be a good choice, which is exciting. Dr. Vamsi Velcheti: Absolutely, completely agree. And I think there are newer ALK inhibitors in clinical development which have cleaner and better safety profiles. So we'll have to kind of wait and see how those pan out.  Moving on to the other exciting abstract, LBA8509, the KRYSTAL-12 study. LBA8509 is a phase 3 study looking at adagrasib versus docetaxel in patients with previously treated advanced metastatic non-small cell cancer with KRASG12C mutation. Nate, there's been a lot of hype around this trial. You've seen the data. Do you think it's practice-changing? How does it differentiate with the other drug that's already FDA approved, sotorasib?  Dr. Nate Pennell: Yeah, this is an interesting one. I think we've all been very excited in recent years about the identification of KRASG12C mutations as targetable mutations. We know that this represents about half of KRAS mutations in patients with non-small cell lung cancer, adenocarcinoma, and there are two FDA-approved drugs. Sotorasib was the first and adagrasib shortly thereafter. We already had seen the CodeBreaK 200 study, which was a phase 3 study of sotorasib versus docetaxel that did modestly prolong progression free survival compared to docetaxel, although did not seem to necessarily translate to an improvement in overall survival. And so now, coming on the heels of that study, the KRYSTAL-12 study compared adagrasib, also the KRASG12C  inhibitor versus docetaxel and those with previously treated non-small cell with KRASG12C. And it did significantly improve progression free survival with a hazard ratio of 0.58. Although when you look at the median numbers, the median PFS was only 5.5 months with the adagrasib arm compared to 3.8 months with docetaxel. So while it is a significant and potentially clinically significant difference, it is still, I would say a modest improvement.   And there were some pretty broad improvements across all the different subgroups, including those with brain metastases. It did improve response rate significantly. So 32% response rate without adagrasib, compared to only 9% with docetaxel. It's about what you would expect with chemotherapy. And very importantly, in this patient population, there was activity in the brain with an intracranial overall response rate among those who had measurable brain metastases of 40%. So certainly important and probably that would distinguish it from drugs like docetaxel, which we don't expect to have a lot of intracranial toxicity. There is certainly a pattern of side effects that go along with that adagrasib, so it does cause especially GI toxicity, like diarrhea, nausea, vomiting, transaminitis. All of these were actually, at least numerically, somewhat higher in the adagrasib arm than in docetaxel, a lot more hematologic toxicity with the docetaxel. But overall, the number of serious adverse events were actually pretty well matched between the two groups. So it wasn't really a home run in terms of favorable toxicity with that adagrasib.  So the question is: “In the absence of any data yet on overall survival, should this change practice?” And I'm not sure it's going to change practice, because I do think that based on the accelerated approval, most physicians are already offering the G12C inhibitors like sotorasib and adagrasib, probably more often than chemotherapy, I think based on perceived improvement in side effects and higher response rates, modestly longer progression-free survival, so I think most people think that represents a modest improvement over chemotherapy. And so I think that will continue. It will be very interesting, however, when the overall survival report is out, if it is not significantly better, what the FDA is going to do when they look at these drugs.  Dr. Vamsi Velcheti: Thanks so much. Very well summarized. And I do agree they look more similar than dissimilar. I think CodeBreaK-200 and the KRYSTAL-12, they kind of are very identical. I should say, though I was a little surprised with the toxicity profile of adagrasib. It seemed, I mean, not significantly, but definitely seemed worse than the earlier readouts that we've seen. The GI tox especially seems much worse on this trial. I'm kind of curious why, but if I recall correctly, I think 5% of the patients had grade 3 diarrhea. A significant proportion of patients had grade 3 nausea and vomiting. And the other complicating thing here is you can't use a lot of the antiemetics because of the QT issues. So that's another problem. But I think it's more comparable to sotorasib, in my opinion.  Dr. Nate Pennell: While this is exciting, I like to think of this as the early days of EGFR, when we were using gefitinib and erlotinib. They were certainly advances, but we now have drugs that are much more effective and long lasting in these patients. And I think that the first-generation inhibitors like sotorasib and adagrasib, while they certainly benefit patients, now is just the beginning. There's a lot of research going on, and we're not going to talk about some of the other abstracts presented, but some of the next generation G12C inhibitors, for example, olomorasib, which did have also in the same session, a presentation in combination with pembrolizumab that had a very impressive response rate with potentially fewer side effects, may end up replacing the first generation drugs when they get a little bit farther along. And then moving on to another one, which I think potentially could change practice. I am curious to hear your take on it, was the LBA8505, which was the PALOMA-3 study. This was interesting in that it compared two different versions of the same drug. So amivantamab, the bispecific, EGFR and MET, which is already approved for EGFR exon 20 non-small cell lung cancer, in this case, in more typical EGFR-mutated non-small cell lung cancer in combination with osimertinib with the intravenous amivantamab, compared to the subcutaneous formulation of amivantamab. Why would this be an important study? Dr. Vamsi Velcheti: I found this study really interesting as well, Nate. And as you know, amivantamab has been FDA approved for patients with exon 20 mutation. And also, we've had, like two positive readouts in patients with classical EGFR mutations. One, the MARIPOSA study in the frontline setting and the MARIPOSA-2, in the second-line post osimertinib setting. For those studies, the intravenous amivantamab was used as a treatment arm, and the intravenous amivantamab had a lot of baggage to go along with it, like the infusion reactions and VTEs and other classic EGFR related toxicity, skin toxicities. So the idea behind developing the subcutaneous formulation of amivantamab was mainly to reduce the burden of infusion, infusion time and most importantly, the infusion related reactions associated with IV formulation.  In a smaller phase 2 study, the PALOMA study, they had looked at various dosing schemas like, subcutaneous formulation, and they found that the infusion related reactions were very, very low with the subcutaneous formulation. So that led to the design of this current study that was presented, the PALOMA-3 study. This was for patients who had classical EGFR mutations like exon 19, L858R. The patients were randomized 1:1 to subcutaneous amivantamab with lazertinib versus IV amivantamab plus lazertinib. The endpoints for the study, it's a non-inferiority study with co primary endpoints of C trough and C2 AUC, Cycle 2 AUC. They were looking at those pharmacological endpoints to kind of demonstrate comparability to the IV formulation. So in this study, they looked at these pharmacokinetic endpoints and they were essentially identical. Both subcutaneous and IV formulations were compatible. And in terms of clinical efficacy as well, the response rate was identical, no significant differences. Duration of response was also identical. The PFS also was comparable to the IV formulation. In fact, numerically, the subcutaneous arm was a little better, though not significant. But it appears like, you know, the overall clinical and pharmacological profile of the subcutaneous amivantamab was comparable. And most interestingly, the AE profile, the skin toxicity was not much different. However, the infusion reactions were substantially lower, 13% with the subcutaneous amivantamab and 66% with IV amivantamab. And also, interestingly, the VTE rates were lower with the subcutaneous version of amivantamab. There was still a substantial proportion of patients, especially those who didn't have prophylactic anticoagulation. 17% of the patients with the subcutaneous amivantamab had VTE versus 26% with IV amivantamab. With prophylaxis, which is lower in both IV and subcutaneous, but still subcutaneous formulation at a lower 7% versus 12% with the IV amivantamab.  So overall, I think this is an interesting study, and also the authors had actually presented some interesting data on administration time. I've never seen this before. Patients reported convenience using a modified score of patient convenience, essentially like patients having to spend a lot of time in the infusion site and convenience of the patient getting the treatment. And it turns out, and no surprise, that subcutaneous amivantamab was found to be more convenient for patients.  So, Nate, I want to ask you your take on this. In a lot of our busy infusion centers, the time it takes for those patients to get the infusion does matter, right? And I think in our clinic where we are kind of fully booked for the infusion, I think having the patients come in and leave in 15, 20 minutes, I think it adds a lot of value to the cancer center operation.  Dr. Nate Pennell: Oh, I completely agree. I think the efficacy results were reassuring. I think the infusion related reaction difference, I think is a huge difference. I mean, I have given a fair amount of amivantamab, and I would say the published IRR rate of 66%, 67% I would say, is maybe even underestimates how many patients get some kind of reaction from that, although it really is a first dose phenomenon. And I think that taking that down to 13% is a tremendous advance. I think fusion share time is not trivial as we get busier and busier. I know our cancer center is also very full and it becomes challenging to schedule people, and being able to do a five-minute treatment versus a five-hour treatment makes a big difference for patients.  It's interesting, there was one slide that was presented from an efficacy standpoint. I'm curious about your take on this. They showed that the overall survival was actually better in the subcu amivantamab arm, hazard ratio of 0.62. Now, this was only an exploratory endpoint. They sort of talk about perhaps some rationale for why this might be the case. But at the very least, I think we can be reassured that it's not less effective to give it and does seem to be more tolerable and so I would expect that this hopefully will be fairly widely adopted. Dr. Vamsi Velcheti: Yeah, I agree. I think this is a welcome change. Like, I think the infusion reactions and the resources it takes to get patients through treatments. I think it's definitely a win-win for patients and also the providers.  And with that, we come to the conclusion of the podcast. Nate, thank you so much for the fantastic insights today. Our listeners will find all the abstracts discussed today in the transcripts of the episode. Thank you so much for joining us today, Dr. Pennell.  Dr. Nate Pennell: Oh, thanks for inviting me. It's always fun to talk about all these exciting advances for our patients. Dr. Vamsi Velcheti: Thanks to our listeners for your time today. You will find links to all the abstracts discussed today in the transcript of the episode. Finally, if you value the insights that you hear from ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcast.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Find out more about today's speakers:    Dr. Vamsi Velcheti  @VamsiVelcheti    Dr. Nathan Pennell  @n8pennell    Follow ASCO on social media:      @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:  Dr. Vamsi Velcheti:  Honoraria: ITeos Therapeutics  Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus  Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline  Dr. Nathan Pennell:    Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron   Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi

All of us can agree that the rates of obesity are progressively climbing, not just in the US, but globally. Obesity is a known independent risk factor in pregnancy for VTE. Several professional societies (ACOG, CMQCC, RCOG, SMFM) have clear recommendations for VTE pharmacoprophylaxis in patients considered at high risk. These include having a high risk thrombophilia, having a personal history of VTE, or having multiple risk factors. But these recommendations address POSTPARTUM prophylaxis. The ACOG does not specifically address inpatient prophylaxis during the antepartum interval. However, in cases of prolonged antepartum admission, where ambulation may be slightly limited, there is concern that the hypercoagulable state of pregnancy, together with obesity, may raise the risk of VTE in these antepartum patients. To be clear, no professional organization or guidelines recommend strict bedrest for pregnancy complications. Is VTE pharmacoprophylaxis endorsed in these admitted antepartum patients? The answer is both YES and NO. The use of heparin based agents in this group is controversial, with published expert opinions having a dichotomy of thought. Plus, recent data (2023) has raised questions regarding pharmacoprophylaxis' efficacy in the postpartum interval. nonetheless, at the end of the episode, will provide some common sense approaches to VTE prevention in the admitted antepartum, obese patient. (With a special shout-out to our podcast family in Australia.).

In this episode, we discuss principles for medication use in the geriatric patient population and summarize the updated 2023 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Key Concepts The Beer's Criteria was originally developed by Dr. Mark Beers in 1991 to identify medications in which the risks may outweigh the benefits in nursing home patients. This list is now maintained by the American Geriatrics Society and includes a variety of drug safety information related to elderly patients including medications that are considered potentially inappropriate (Table 2 and 3), medications used with caution (Table 4), drug-drug interactions (Table 5), drugs with renal dose adjustments (Table 6), and drugs with anticholinergic properties (Table 7). The newest update prefers apixaban over other DOACs for VTE and atrial fibrillation in elderly patients. This is a very controversial recommendation given that other guidelines (e.g. from the ACC/AHA) have not published a similar preference of one DOAC over another. Many of the medications that are potentially inappropriate involve drugs that have anticholinergic properties and drugs that increase the risk of incoordination and falls. Other resources exist to guide drug therapy decisions in elderly patients. As an example, the STOPP/START criteria (published in the European Geriatric Medicine journal) outlines drugs to avoid but also drugs to consider in elderly patients. References By the 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J AM Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372. O'Mahony D, Cherubini A, Guiteras AR, Denkinger M, Beuscart JB, Onder G, Gudmundsson A, Cruz-Jentoft AJ, Knol W, Bahat G, van der Velde N, Petrovic M, Curtin D. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med. 2023 Aug;14(4):625-632. doi: 10.1007/s41999-023-00777-y.

The ACOG, CDC, and WHO currently do not recommend universal screening for thrombophilia in the general population before starting oral contraceptive pills. However, a new publication in AJOG (March 2024) is challenging that stance. In this episode, we will review this new prospective population-based study to see if it makes the case for universal screening for thrombophilia variants before starting OCPs. In this episode, we'll also discuss high-risk versus low-risk thrombophilia, discuss relative risk versus absolute risk of VTE on the combination pill, and give clear clinical implications for patient management.