Podcasts about VTE

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

Send us a textThis episode reviews findings from a cross-sectional study at SickKids on health literacy in pediatric VTE patients and caregivers (Res Pract Thromb Haemost, 2025). Among 101 participants, 74% of adolescents and 59% of parents/caregivers demonstrated low general health literacy using REALM, HAS-A, and eHEALS instruments. Communication with providers was the most affected domain, and fewer than half of participants were satisfied with their thrombosis knowledge. Adolescents frequently overestimated their understanding, underscoring the need for simplified educational resources and a “universal precautions” approach to health literacy in pediatric thrombosis care.AboutKidsHealth Thrombosis Hub: https://www.aboutkidshealth.ca/thrombosisBastas, D., Mancini, A., Wong, G., Brandão, L. R., Mukaj, S., Vincelli, J., ... & Avila, L. (2025). Health literacy in pediatric thrombosis: a landscape analysis. Research and Practice in Thrombosis and Haemostasis, 9(1), 102653.Publication Link: https://www.rpthjournal.org/article/S2475-0379%2824%2900348-0/fulltextSupport 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

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

Send us a textIn this episode of CLOT Conversations, we discuss the newly developed Orthopedic Surgery VTE Thromboprophylaxis Guideline Summary. Dr. Marc Carrier, a hematologist and key author, highlights the need for a multidisciplinary approach in managing venous thromboembolism (VTE) risks, particularly in orthopedic surgery. The conversation covers preoperative risk assessments, options for pharmacological and mechanical thromboprophylaxis, and the evolving landscape of surgical techniques that influence thrombosis risk. The episode emphasizes the importance of providing clinicians with practical tools to effectively navigate VTE prevention.Access the full review paper here: https://thrombosiscanada.ca/uploads/publications/WhitePapers/TC135_VTE_Whitepaper_v4.pdfSupport 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

Send us a textIn this episode of CLOT Conversations, experts discuss recent research on cancer-associated thrombosis and the predictors of recurrent venous thromboembolism (VTE) and anticoagulant-related bleeding. Dr. Faizan Khan, a leading researcher in the field, explains the results of their study that aimed to offer a comprehensive understanding of the prognostic factors associated with these risks. Hear what he says about the evidence for associations of several patient- and cancer-related factors, and the risk of recurrent VTE. This research is expected to inform clinical practice by promoting a more individualized approach to anticoagulant management in cancer patients.Reference: Khan, F., Tritschler, T., Marx, C. E., Lanting, V., Rochwerg, B., Tran, A., ... & Carrier, M. (2025). Predictors of recurrent venous thromboembolism and bleeding in patients with cancer: a meta-analysis. European Heart Journal, ehaf453.https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaf453/8170116?login=falseSupport 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

Send us a textDid you know that nearly 1 in 10 cancer patients worldwide may develop a potentially deadly blood clot? In this episode, we speak with researcher Jordan Harry, lead author of a landmark systematic review just published in Cancer Epidemiology, that uncovers which solid tumors carry the highest risk of venous thromboembolism (VTE) and where in the world patients are most vulnerable.Jordan walks us through surprising insights from their analysis of over 120 studies: 

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

Send us a textIn this episode of Clot Conversations, hosts Jamil Abdulrehman, and Maha Othman interview Dr Stephanie Young from Memorial University in St John's, Newfoundland, at the 2025 ISTH meeting about her presentations on the complexities of patient experiences with Venous Thromboembolism (VTE). Dr Young shares findings from a qualitative study that highlight the uncertainties and emotional impacts patients face along their care journey. Key themes include the need for clearer care pathways, better access to specialized services, and greater involvement in decision-making. The discussion emphasizes integrating patient insights into clinical guidelines to enhance VTE care, aiming for a more patient-centered approach that accounts for both physical and psychological needs.Dr Young also references the Thrombosis Canada patient resources that can be found here: https://thrombosiscanada.ca/patients_and_caregiversSupport 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

Send us a textIn this podcast episode, we explore groundbreaking research presented at the ISTH 2025 in Washington. Dr. Vicky May, Institut Universitaire de Cardiologie et Pneumologie de Québec, shares insights into a new diagnostic algorithm for pulmonary embolism (PE) in patients with chronic obstructive pulmonary disease (COPD). Her work focuses on identifying specific predictors, integrating these with established testing methods, and addressing challenges in the validation process. The discussion also highlights a study on recurrent venous thromboembolism (VTE), emphasizing symptom patterns and recurrence likelihood. These findings aim to refine clinical diagnostics, offering physicians refined tools for better patient management in thrombosis-related conditions.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

Send us a textIn this episode of Clot Conversations, Dr. Lana Castellucci, University of Ottawa, discusses the COBRA study, which compares the bleeding risks of rivaroxaban and apixaban in patients with acute VTE. The study follows patients for three months and finds that apixaban significantly reduces combined bleeding events compared to rivaroxaban. While the trial wasn't powered for individual outcomes, it shows no difference in VTE recurrence. This is potentially practice-changing information, indicating that most acute VTE patients might benefit from apixaban over rivaroxaban, although patient-specific factors and preferences will still play a role in decision-making.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

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.

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

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

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,

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

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.