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In this episode, we discuss for educational purposes only, the concepts associated with VTEs and the relevant pharmacotherapeutics, for pharmacists in training. ---- Note: The views of this podcast represent those of my guest(s) and I. -- Note: Purpose of these episodes- not at all, for advice or medical suggestions. These are aimed to provide support for peer pharmacists in training in educational and intellectually stimulating ways. Again, these are not at all for medical advice, or for medical suggestions. Please see your local state and board-certified physician, PA or NP, and pharmacist for medical advice and suggestions. --- Note: Some of the content produced involved the use of A.I. .
En esta ocasión hablamos de el Presente y Futuro del VtES. Escucha el podcast de nuestros amigos "El libro de Noob" directamente desde Chile. ¡acá el link! https://open.spotify.com/show/30COjBbUks4a4hbnTqpgXZ?si=15f1b92a0e6b401d Escucha el podcast de nuestros amigos "Bleed de 3" directamente desde España. ¡acá el link! https://open.spotify.com/show/2dot8G5KfmVuBnBPsyPoVd?si=cb569d96661f44af VtES México: https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Carlos https://www.instagram.com/cesc0bar/ Alberto https://www.instagram.com/diosenfermo/ Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Cuenta de El setita loco (mazos ganadores y finalistas) https://www.instagram.com/elsetitaloco/?hl=es La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://podcasters.spotify.com/pod/show/master-phase/support
Drs. Vamsi Velcheti and Nathan Pennell discuss novel approaches and key studies in lung cancer that were showcased at the 2024 ASCO Annual Meeting, including the Plenary abstracts LAURA and ADRIATIC. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I am Dr. Vamsi Velcheti, your guest host for the ASCO Daily News Podcast today. I'm a professor of medicine and director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Health. Today, I'm joined by Dr. Nate Pennell, the co-director of the Cleveland Clinic Lung Cancer Program and the vice chair of clinical research at the Taussig Cancer Center in Cleveland Clinic. Dr. Pennell is also the editor-in-chief of the ASCO Educational Book. Today, we will be discussing practice-changing abstracts and the exciting advances in lung cancer that were featured at the ASCO 2024 Annual Meeting. You'll find our full disclosures in the transcript of the episode. Nate, we're delighted to have you back on the podcast today. Thanks for being here. It was an exciting Annual Meeting with a lot of important updates in lung cancer. Dr. Nate Pennell: Thanks, Vamsi. I'm glad to be back. And yes, it was a huge year for lung. So I'm glad that we got a chance to discuss all of these late-breaking abstracts that we didn't get to talk about during the prelim podcast. Dr. Vamsi Velcheti: Let's dive in. Nate, it was wonderful to see all the exciting data, and one of the abstracts in the Plenary Session caught my attention, LBA3. In this study, the investigators did a comparative large-scale effectiveness trial of early palliative care delivered via telehealth versus in-person among patients with advanced non-small cell lung cancer. And the study is very promising. Could you tell us a little bit more about the study and your take-home messages? Dr. Nate Pennell: Yes, I think this was a very important study. So just to put things in perspective, it's now been more than a decade since Dr. Jennifer Temel and her group at Massachusetts General Hospital did a randomized study that showed that early interventions with palliative medicine consultation in patients with advanced non-small cell lung cancer significantly improves quality of life and in her initial study, perhaps even overall survival. And since then, there have been numerous studies that have basically reproduced this effect, showing that getting palliative medicine involved in people with advanced cancer, multiple different cancer types, really, has benefits. The difficulty in applying this has been that palliative care-trained specialists are few and far between, and many people simply don't have easy access to palliative medicine-trained physicians and providers. So with that in mind, Dr. Temel and her group designed a randomized study called the REACH PC trial, where 1,250 patients were randomized with advanced non-small cell lung cancer to either in-person palliative medicine visits which is sort of the standard, or one in-person assessment followed by monthly telemedicine video visits with palliative medicine. Primary endpoint was essentially to show that it was equivalent in terms of quality of life and patient satisfaction. And what was exciting about this was that it absolutely was. I mean, pretty much across the board in all the metrics that were measured, the quality-of-life, the patient satisfaction, the anxiety and depression scores, all were equivalent between doing telemedicine visits and in-person visits. And this hopefully will now extend the ability to get this kind of benefit to a much larger group of people who don't have to geographically be located near a palliative medicine program. Dr. Vamsi Velcheti: Yeah, I think it's a great abstract, Nate and I actually was very impressed by the ASCO committee for selecting this for the Plenary. We typically don't see supportive care studies highlighted in such a way at ASCO. This really highlights the need for true interdisciplinary care for our patients. And as you said, this study will clearly address that unmet need in terms of providing access to palliative care for a lot of patients who otherwise wouldn't have access. I'm really glad to see those results. Dr. Nate Pennell: It was. And that really went along with Dr. Schuchter's theme this year of bringing care to patients incorporating supportive care. So I agree with you. Now, moving to some of the other exciting abstracts in the Plenary Session. So we were talking about how this was a big year for lung cancer. There were actually 3 lung cancer studies in the Plenary Session at the Annual Meeting. And let's move on to the second one, LBA4, the LAURA study. This was the first phase 3 study to assess osimertinib, an EGFR tyrosine kinase inhibitor, in patients with EGFR mutant, unresectable stage III non-small cell lung cancer. What are your takeaways from this study? Dr. Vamsi Velcheti: This is certainly an exciting study, and all of us in the lung community have been kind of eagerly awaiting the results of the study. As you know, for stage III non-small cell lung cancer patients who are unresectable, the standard of care has been really established by the PACIFIC study with the consolidation durvalumab after definitive concurrent chemoradiation. The problem with that study is it doesn't really answer the question of the role of immunotherapy in patients who are never-smokers, and especially in patients who are EGFR positive tumors, where the role of immunotherapy in a metastatic setting has always been questioned. And in fact, there have been several studies as you know, in patients with EGFR mutation positive metastatic lung cancer where immunotherapy has not been that effective. In fact, in the subgroup analysis in the PACIFIC study, patients with EGFR mutation did not really benefit from adding immunotherapy. So this is an interesting study where they looked at patients with locally advanced, unresectable stage III patients and they randomized the patients 2:1 to osimertinib versus placebo following concurrent or sequential tumor radiation. The primary endpoint for the study was progression free survival, and a total of 216 patients were enrolled and 143 patients received a study treatment, which is osimertinib, and 73 received placebo. And 80% of the patients on the placebo arm crossed over to getting treatment at the time of progression. So most of us in the lung cancer community were kind of suspecting this would be a positive trial for PFS. But however, I think the magnitude of the difference was truly remarkable. The median PFS in the osimertinib arm was 39.1 months and placebo was 5.6 months and the hazard ratio of 0.16. So it was a pretty striking difference in terms of DFS benefit with the osimertinib consolidation following chemoradiation. So it was truly a positive study for the primary endpoint and the benefit was seen across all the subgroups and the safety was no unexpected safety signals other than a slight increase in the radiation pneumonitis rates in patients receiving osimertinib and other GI and skin tox were kind of as expected. In my opinion, it's truly practice changing and I think patients with EGFR mutation should not be getting immunotherapy consolidation post chemoradiation. Dr. Nate Pennell: I completely agree with you. I think that this really just continues the understanding of the use of osimertinib in EGFR-mutant lung cancer in earlier stages of disease. We know from the ADAURA trial, presented twice in the Plenary at the ASCO Annual Meeting, that for IB, stage II and resectable IIIA, that you prolong progression free or disease free survival. So this is a very similar, comparable situation, but at an even higher risk population or the unresectable stage III patients. I think that the most discussion about this was the fact that the osimertinib is indefinite and that it is distinct from the adjuvant setting where it's being given for three years and then stopped. But I think all of us had some pause when we saw that after three years, especially in the stage III patients from ADAURA, that there were clearly an increase in recurrences after stopping the drug, suggesting that there are patients who are not cured with a time limited treatment, or at least with 3 years of treatment. The other thing that is sobering from the study, and was pointed out by the discussant, Dr. Lecia Sequist, is if you look at the two-year disease-free survival in the placebo arm, it was only 13%, meaning almost no one was really cured with chemo radiation alone. And that really suggests that this is not that different from a very early stage IV population where indefinite treatment really is the standard of care. I wonder whether you think that's a reasonable approach. Dr. Vamsi Velcheti: I completely agree with you, Nate, and I don't think we cure a majority of our patients with stage III, and less so in patients who have EGFR-mutant, stage III locally advanced. As you just pointed out, I think very few patients actually make it that far along. And I think there's a very high rate of CNS micrometastatic disease or just systemic micrometastatic disease in this population that an effective systemic therapy of osimertinib can potentially have long term outcomes. But again, we perhaps don't cure a vast majority of them. I think that the next wave of studies should incorporate ctDNA and MRD-based assays to potentially identify those patients who could potentially go off osimertinib at some point. But, again, outside of a trial, I would not be doing that. But I think it's definitely an important question to ask to identify de-escalation strategies with osimertinib. And even immunotherapy for that matter, I think we all know that not all patients really require years and years of immunotherapy. They're still trying to figure out how to use immunotherapy in these post-surgical settings, using the MRD to de-escalate adjuvant therapies. So I think we have to have some sort of strategy here. But outside of a clinical trial, I will not be using those assays here to cite treatments, but certainly an important question to ask. Moving on to the other exciting late-breaking abstracts, LBA5, the ADRIATIC study. This is another study which was also in the plenary session. This study was designed to address this question of consolidation immunotherapy, post chemo radiation for limited-stage small cell cancer, the treatment arms being durvalumab tremelimumab, and durvalumab observation. So what do you think about the study? This study also received a lot of applause and a lot of attention at the ASCO meeting. Dr. Nate Pennell: It was. It was remarkable to be there and actually watch this study as well as the LAURA study live, because when the disease free survival curves and in the ADRIATIC study, the overall survival curves were shown, the speakers were both interrupted by standing ovation of applause just because there was a recognition that the treatment was changing kind of before our eyes. I thought that was really neat. So in this case, I think this is truly a historic study, not necessarily because it's going to necessarily be an earth shakingly positive study. I mean, it was clearly a positive study, but more simply because of the disease in which it was done, and that is limited-stage small cell lung cancer. We really have not had a change in the way we've treated limited-stage small cell lung cancer, probably 25 years. Maybe the last significant advances in that were the advent of concurrent chemotherapy and radiation and then the use of PCI with a very modest improvement in survival. Both of those, I would say, are still relatively modest advances. In this case, the addition of immunotherapy, which we know helps patients with small cell lung cancer - it's of course the standard of care in combination chemotherapy for extensive stage small cell lung cancer - in this case, patients who completed concurrent chemo radiation were then randomized to either placebo or durvalumab, as well as the third arm of durvalumab tremelimumab, which is not yet been recorded, and co primary endpoints were overall survival and progression free survival. And extraordinarily, there was an improvement in overall survival seen at the first analysis, with a median overall survival of 55.9 months compared to 33.4 months, hazard ratio of 0.73. So highly clinically and statistically significant, that translates at three years to a difference in overall survival of 56.5%, compared to 47.6%, or almost 10% improvement in survival at three years. There was also a nearly identical improvement in progression-free survival, also with a hazard ratio of 0.76, suggesting that there's a modest number of patients who benefit. But it seems to be a clear improvement with the curves plateauing out. In my opinion, this is very comparable to what we saw with the PACIFIC study in stage III, unresectable non-small cell lung cancer, which immediately changed practice back when that first was reported. And I expect that this will change practice pretty much immediately for small cell as well. Dr. Vamsi Velcheti: Yeah, I completely agree, Nate. I think it's an exciting advance in patients with limited-stage small cell lung cancer. For sure, it's practice-changing, and I think the results were exciting. So one thing that really intrigued me was in the extensive-stage setting, the benefit was very mediocre with one-to-two month overall survival benefit in both the PACIFIC and in IMpower trial. Here we are seeing almost two-year of median OS benefit. I was kind of puzzled by that, and I thought it may have to do with patients receiving radiation. And we've seen that with the PACIFIC, and makes you wonder if both the CASPIAN and the IMpower studies actually did not allow consolidation thoracic radiation. Hypothetically, if they had allowed consolidation thoracic radiation, perhaps we would have seen better outcomes. Any thoughts on that? Dr. Nate Pennell: We've been trying to prove that radiation and immunotherapy somehow go together better for a long time. Going back to the first description of the abscopal effect, and I'm not sure if I necessarily believe that to be the case, but in this setting where we truly are trying to cure people rather than merely prolong their survival, maybe this is the situation where it truly is more beneficial. I think what we're seeing is something very similar to what we're seen in PACIFIC, where in the stage IV setting, some people have long term survival with immunotherapy, but it's relatively modest. But perhaps in the curative setting, you're seeing more of an impact. Certainly, looking at these curves, we'll have to see with another couple of years to follow up. But a three-year survival of 56% is pretty extraordinary, and I look forward to seeing if this really maintains over the next couple of years follow up. Moving beyond the Plenary, there were actually lots of really exciting presentations, even outside the Plenary section. One that I think probably got at least as much attention as the ones that we've already discussed today was actually an update of an old trial that's been presented for several prior years. And I'm curious to get your take on why you thought this was such a remarkable study. And we're talking about the LBA8503, which was the 5-year update from the CROWN study, which looked at previously untreated ALK-positive advanced non-small cell in cancer patients randomly assigned to lorlatinib, the third generation ALK inhibitor, versus crizotinib, the first generation ALK inhibitor. What was so exciting about this study, and why were people talking about it? Dr. Vamsi Velcheti: Yeah, I agree, Nate. We've seen the data in the past, right? Like on the CROWN data, just first like a quick recap. This is the CROWN study, like the phase 3 study of third generation ALK inhibitor lorlatinib. So global randomized phase 3 study in patients with metastatic disease randomized to lorlatinib versus crizotinib, which is a controller. So the primary endpoint was PFS, and we've seen the results in the past of the CROWN readout quoted, with a positive study and the lorlatinib received FDA approval in the frontline setting. But the current study that was presented at the ASCO annual meeting is a kind of a postdoc analysis of five years. The endpoint for the study with central review stopped at three years, and this is actually a follow up beyond that last readout. Interestingly, in this study, when they looked at the median PFS at five years, the lorlatinib arm did not reach a median PFS even at five years and the hazard ratio is 0.19, which is kind of phenomenal in some ways. At 5 years, the majority of the patients were still on the drug. So that's quite incredible. And the benefit was more profound in patients with brain mets with a hazard ratio of 0.08. And again, speaking to the importance of brain penetrant, small molecule inhibitors, and target therapy, the safety profile, there were no additional safety signals noted in the study. We kind of know about the side effects of lorlatinib already from previous studies readouts. No unusual long-term toxicities. I should note though, about 40% of patients did have CNS, AEs grade 1, 2 CNS toxicities on the lorlatinib arm. And the other interesting thing that was also reported in the trial was dose reduction of lorlatinib did not have an impact on the PFS, which is interesting in my opinion. They also did some subgroup analysis, biomarker testing, biomarker populations. Patients who had P53 cooperation did much better with lorlatinib versus crizotinib. So overall, the other thing that they also had shown on the trial was the resistance mechanisms that were seen with lorlatinib were very different than what we are used to seeing with the earlier generation ALK inhibitors. The majority of the patients who develop resistance have bypass mechanisms and alterations in MAP kinase pathway PI3K/MTOR/PTEN pathway, suggesting that lorlatinib is a very potent ALK inhibitor and on target ALK mutations don't happen as frequently as we see with the earlier generation ALK inhibitors. So I think this really begs the question, should we offer lorlatinib to all our patients with metastatic ALK-positive tumors? I think looking at the long-term data, it's quite tempting to say ‘yes', but I think at the same time we have to take into consideration patient safety tolerability. And again, the competitor arm here is crizotinib. So lorlatinib suddenly seems to be, again, cross trial comparisons, but I think the long-term outcomes here are really phenomenal. But at the same time, I think we've got to kind of think about patient because these patients are on these drugs for years, they have to live with all the toxicities. And I think the patient preferences and safety profile matters in terms of what drug we recommend to patients. Dr. Nate Pennell: I completely agree with you. I think the right answer, is that this has to be an individual discussion with patients. The results are incredibly exciting. I mean, the two-year progression free survival was 70%, and the five-year, three years later is still 60%. Only 10% of people are failing over the subsequent three years. And the line is pretty flat. And as you said, even with brain metastases, the median survival is in reach. It's really extraordinary. Moreover, while we do talk about the significant toxicities of lorlatinib, I thought it was really interesting that only 5% of people were supposedly discontinued the drug because of treatment related AEs, which meant that with dose reduction and management, it seems as though most patients were able to continue on the drug, even though they, as you mentioned, were taking it for several years. That being said, all of us who've had experience with the second-generation drugs like alectinib and brigatinib, compared to the third-generation drug lorlatinib, can speak to the challenges of some of the unique toxicities that go along with it. I don't think this is going to be a drug for everyone, but I do think it is now worth bringing it up and discussing it with the patients most of the time now. And I do think that there will be many people for whom this is going to be a good choice, which is exciting. Dr. Vamsi Velcheti: Absolutely, completely agree. And I think there are newer ALK inhibitors in clinical development which have cleaner and better safety profiles. So we'll have to kind of wait and see how those pan out. Moving on to the other exciting abstract, LBA8509, the KRYSTAL-12 study. LBA8509 is a phase 3 study looking at adagrasib versus docetaxel in patients with previously treated advanced metastatic non-small cell cancer with KRASG12C mutation. Nate, there's been a lot of hype around this trial. You've seen the data. Do you think it's practice-changing? How does it differentiate with the other drug that's already FDA approved, sotorasib? Dr. Nate Pennell: Yeah, this is an interesting one. I think we've all been very excited in recent years about the identification of KRASG12C mutations as targetable mutations. We know that this represents about half of KRAS mutations in patients with non-small cell lung cancer, adenocarcinoma, and there are two FDA-approved drugs. Sotorasib was the first and adagrasib shortly thereafter. We already had seen the CodeBreaK 200 study, which was a phase 3 study of sotorasib versus docetaxel that did modestly prolong progression free survival compared to docetaxel, although did not seem to necessarily translate to an improvement in overall survival. And so now, coming on the heels of that study, the KRYSTAL-12 study compared adagrasib, also the KRASG12C inhibitor versus docetaxel and those with previously treated non-small cell with KRASG12C. And it did significantly improve progression free survival with a hazard ratio of 0.58. Although when you look at the median numbers, the median PFS was only 5.5 months with the adagrasib arm compared to 3.8 months with docetaxel. So while it is a significant and potentially clinically significant difference, it is still, I would say a modest improvement. And there were some pretty broad improvements across all the different subgroups, including those with brain metastases. It did improve response rate significantly. So 32% response rate without adagrasib, compared to only 9% with docetaxel. It's about what you would expect with chemotherapy. And very importantly, in this patient population, there was activity in the brain with an intracranial overall response rate among those who had measurable brain metastases of 40%. So certainly important and probably that would distinguish it from drugs like docetaxel, which we don't expect to have a lot of intracranial toxicity. There is certainly a pattern of side effects that go along with that adagrasib, so it does cause especially GI toxicity, like diarrhea, nausea, vomiting, transaminitis. All of these were actually, at least numerically, somewhat higher in the adagrasib arm than in docetaxel, a lot more hematologic toxicity with the docetaxel. But overall, the number of serious adverse events were actually pretty well matched between the two groups. So it wasn't really a home run in terms of favorable toxicity with that adagrasib. So the question is: “In the absence of any data yet on overall survival, should this change practice?” And I'm not sure it's going to change practice, because I do think that based on the accelerated approval, most physicians are already offering the G12C inhibitors like sotorasib and adagrasib, probably more often than chemotherapy, I think based on perceived improvement in side effects and higher response rates, modestly longer progression-free survival, so I think most people think that represents a modest improvement over chemotherapy. And so I think that will continue. It will be very interesting, however, when the overall survival report is out, if it is not significantly better, what the FDA is going to do when they look at these drugs. Dr. Vamsi Velcheti: Thanks so much. Very well summarized. And I do agree they look more similar than dissimilar. I think CodeBreaK-200 and the KRYSTAL-12, they kind of are very identical. I should say, though I was a little surprised with the toxicity profile of adagrasib. It seemed, I mean, not significantly, but definitely seemed worse than the earlier readouts that we've seen. The GI tox especially seems much worse on this trial. I'm kind of curious why, but if I recall correctly, I think 5% of the patients had grade 3 diarrhea. A significant proportion of patients had grade 3 nausea and vomiting. And the other complicating thing here is you can't use a lot of the antiemetics because of the QT issues. So that's another problem. But I think it's more comparable to sotorasib, in my opinion. Dr. Nate Pennell: While this is exciting, I like to think of this as the early days of EGFR, when we were using gefitinib and erlotinib. They were certainly advances, but we now have drugs that are much more effective and long lasting in these patients. And I think that the first-generation inhibitors like sotorasib and adagrasib, while they certainly benefit patients, now is just the beginning. There's a lot of research going on, and we're not going to talk about some of the other abstracts presented, but some of the next generation G12C inhibitors, for example, olomorasib, which did have also in the same session, a presentation in combination with pembrolizumab that had a very impressive response rate with potentially fewer side effects, may end up replacing the first generation drugs when they get a little bit farther along. And then moving on to another one, which I think potentially could change practice. I am curious to hear your take on it, was the LBA8505, which was the PALOMA-3 study. This was interesting in that it compared two different versions of the same drug. So amivantamab, the bispecific, EGFR and MET, which is already approved for EGFR exon 20 non-small cell lung cancer, in this case, in more typical EGFR-mutated non-small cell lung cancer in combination with osimertinib with the intravenous amivantamab, compared to the subcutaneous formulation of amivantamab. Why would this be an important study? Dr. Vamsi Velcheti: I found this study really interesting as well, Nate. And as you know, amivantamab has been FDA approved for patients with exon 20 mutation. And also, we've had, like two positive readouts in patients with classical EGFR mutations. One, the MARIPOSA study in the frontline setting and the MARIPOSA-2, in the second-line post osimertinib setting. For those studies, the intravenous amivantamab was used as a treatment arm, and the intravenous amivantamab had a lot of baggage to go along with it, like the infusion reactions and VTEs and other classic EGFR related toxicity, skin toxicities. So the idea behind developing the subcutaneous formulation of amivantamab was mainly to reduce the burden of infusion, infusion time and most importantly, the infusion related reactions associated with IV formulation. In a smaller phase 2 study, the PALOMA study, they had looked at various dosing schemas like, subcutaneous formulation, and they found that the infusion related reactions were very, very low with the subcutaneous formulation. So that led to the design of this current study that was presented, the PALOMA-3 study. This was for patients who had classical EGFR mutations like exon 19, L858R. The patients were randomized 1:1 to subcutaneous amivantamab with lazertinib versus IV amivantamab plus lazertinib. The endpoints for the study, it's a non-inferiority study with co primary endpoints of C trough and C2 AUC, Cycle 2 AUC. They were looking at those pharmacological endpoints to kind of demonstrate comparability to the IV formulation. So in this study, they looked at these pharmacokinetic endpoints and they were essentially identical. Both subcutaneous and IV formulations were compatible. And in terms of clinical efficacy as well, the response rate was identical, no significant differences. Duration of response was also identical. The PFS also was comparable to the IV formulation. In fact, numerically, the subcutaneous arm was a little better, though not significant. But it appears like, you know, the overall clinical and pharmacological profile of the subcutaneous amivantamab was comparable. And most interestingly, the AE profile, the skin toxicity was not much different. However, the infusion reactions were substantially lower, 13% with the subcutaneous amivantamab and 66% with IV amivantamab. And also, interestingly, the VTE rates were lower with the subcutaneous version of amivantamab. There was still a substantial proportion of patients, especially those who didn't have prophylactic anticoagulation. 17% of the patients with the subcutaneous amivantamab had VTE versus 26% with IV amivantamab. With prophylaxis, which is lower in both IV and subcutaneous, but still subcutaneous formulation at a lower 7% versus 12% with the IV amivantamab. So overall, I think this is an interesting study, and also the authors had actually presented some interesting data on administration time. I've never seen this before. Patients reported convenience using a modified score of patient convenience, essentially like patients having to spend a lot of time in the infusion site and convenience of the patient getting the treatment. And it turns out, and no surprise, that subcutaneous amivantamab was found to be more convenient for patients. So, Nate, I want to ask you your take on this. In a lot of our busy infusion centers, the time it takes for those patients to get the infusion does matter, right? And I think in our clinic where we are kind of fully booked for the infusion, I think having the patients come in and leave in 15, 20 minutes, I think it adds a lot of value to the cancer center operation. Dr. Nate Pennell: Oh, I completely agree. I think the efficacy results were reassuring. I think the infusion related reaction difference, I think is a huge difference. I mean, I have given a fair amount of amivantamab, and I would say the published IRR rate of 66%, 67% I would say, is maybe even underestimates how many patients get some kind of reaction from that, although it really is a first dose phenomenon. And I think that taking that down to 13% is a tremendous advance. I think fusion share time is not trivial as we get busier and busier. I know our cancer center is also very full and it becomes challenging to schedule people, and being able to do a five-minute treatment versus a five-hour treatment makes a big difference for patients. It's interesting, there was one slide that was presented from an efficacy standpoint. I'm curious about your take on this. They showed that the overall survival was actually better in the subcu amivantamab arm, hazard ratio of 0.62. Now, this was only an exploratory endpoint. They sort of talk about perhaps some rationale for why this might be the case. But at the very least, I think we can be reassured that it's not less effective to give it and does seem to be more tolerable and so I would expect that this hopefully will be fairly widely adopted. Dr. Vamsi Velcheti: Yeah, I agree. I think this is a welcome change. Like, I think the infusion reactions and the resources it takes to get patients through treatments. I think it's definitely a win-win for patients and also the providers. And with that, we come to the conclusion of the podcast. Nate, thank you so much for the fantastic insights today. Our listeners will find all the abstracts discussed today in the transcripts of the episode. Thank you so much for joining us today, Dr. Pennell. Dr. Nate Pennell: Oh, thanks for inviting me. It's always fun to talk about all these exciting advances for our patients. Dr. Vamsi Velcheti: Thanks to our listeners for your time today. You will find links to all the abstracts discussed today in the transcript of the episode. Finally, if you value the insights that you hear from ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcast. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Find out more about today's speakers: Dr. Vamsi Velcheti @VamsiVelcheti Dr. Nathan Pennell @n8pennell Follow ASCO on social media: @ASCO on Twitter ASCO on Facebook ASCO on LinkedIn Disclosures: Dr. Vamsi Velcheti: Honoraria: ITeos Therapeutics Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline Dr. Nathan Pennell: Consulting or Advisory Role: AstraZeneca, Lilly, Cota Healthcare, Merck, Bristol-Myers Squibb, Genentech, Amgen, G1 Therapeutics, Pfizer, Boehringer Ingelheim, Viosera, Xencor, Mirati Therapeutics, Janssen Oncology, Sanofi/Regeneron Research Funding (Inst): Genentech, AstraZeneca, Merck, Loxo, Altor BioScience, Spectrum Pharmaceuticals, Bristol-Myers Squibb, Jounce Therapeutics, Mirati Therapeutics, Heat Biologics, WindMIL, Sanofi
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/right-from-the-onset-pe-diagnosis-management/24232/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/what-options-are-available-prophylactically-for-my-acute-and-post-acute-medically-ill-patients/24228/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/case-time-vt-edwards-management-of-extended-thromboprophylaxis-in-the-medically-ill/24229/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/what-do-the-guidelines-suggest-for-prophylaxis-and-how-do-we-implement/24230/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/right-from-the-onset-dvt-diagnosis-management/24231/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/what-is-the-acute-and-post-acute-risk-of-vte-in-acute-medically-ill-patients/24227/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/case-time-vte-prophylaxis-post-hip-replacement/24233/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/risk-assessment-whos-most-susceptible-for-a-secondary-vte-event/24235/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/vte-prophylaxis-in-patients-at-risk-for-a-secondary-vte-event-options/24236/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/mrs-vt-elizabeth-a-case-study-on-the-secondary-prevention-of-vte/24237/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/how-do-we-effectively-integrate-the-latest-vte-treatment-and-secondary-prevention-guidelines-into-clinical-practice/24238/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
CME credits: 1.75 Valid until: 29-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/putting-it-all-together-coordinating-the-multidisciplinary-care-plan-for-the-patient-with-vte/24234/ Venous thromboembolism (VTE) morbidity, mortality, and impact on the overall quality of life start with timely diagnosis, appropriate initial treatment, and management. Prevention occurs at a primary and secondary level. This program focuses on all the components to manage VTEs at all of these levels to help clinicians effectively manage their patients and reduce preventable harm and corresponding healthcare costs. This program also highlights aspects of the guidelines that can be used daily to help with the management of VTE in daily practice.
Veterinary technician programs have expanded in remarkable ways over the past decade, and there's a push towards getting a four-year degree, with even more advanced degrees on the horizon. This week, we're speaking with the interim Director of Appalachian State University's Veterinary Technology B.S. Program, Jennifer Serling CVT RVT VTES BVSc, to discuss the benefits and pros of a four-year veterinary technician degree and the value of remote education. Hosts Dr. Ernie Ward and Beckie Mossor, RVT, MPA, explore some of the exciting changes and opportunities in in-person and online veterinary technician programs. This week's guest has a long history of innovating veterinary technician curricula, and we're thrilled to cover her thoughts on why obtaining a four-year veterinary technician degree has potential impacts far beyond clinical practice. After you've listened to this week's podcast, please give us a HUGE FAVOR and leave us five stars on Apple Podcasts. Your review helps us reach more of our colleagues with these topics. Thank you! Learn more about Jennifer Sterling and App State's Vet Tech Program: https://rri.appstate.edu/vet-tech https://www.linkedin.com/in/jennifer-serling-75216b15/ #veterinary #veterinarytechnician #veterinary #podcast #veterinarypodcast #vettechpodcast #vetpodcast
En el segundo capitulo de esta 5ta temporada hablamos de la Interactividad y el Combo en VtES, al cual consideramos parte esencial del alma del juego. Escucha el podcast de nuestros amigos "El libro de Noob" directamente desde Chile. ¡acá el link! https://open.spotify.com/show/30COjBbUks4a4hbnTqpgXZ?si=15f1b92a0e6b401d Escucha el podcast de nuestros amigos "Bleed de 3" directamente desde España. ¡acá el link! https://open.spotify.com/show/2dot8G5KfmVuBnBPsyPoVd?si=cb569d96661f44af VtES México: https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Carlos https://www.instagram.com/cesc0bar/ Alberto https://www.instagram.com/diosenfermo/ Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Cuenta de El setita loco (mazos ganadores y finalistas) https://www.instagram.com/elsetitaloco/?hl=es La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Send in a voice message: https://podcasters.spotify.com/pod/show/master-phase/message Support this podcast: https://podcasters.spotify.com/pod/show/master-phase/support
Tuvimos la oportunidad de entrevistar a una de las nuevas ilustradoras para el juego de VtES, María Lorén (Mackeko) Dejen sus comentarios y sugerencias que todos son bienvenidos Instagram María Lorén: https://www.instagram.com/mackeko/ Contáctanos para pedir tu producto: https://wa.me/525525031796 Nuestras redes sociales: VtES México https://vtesmexico.wordpress.com/ https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.gg/vmuZKCDY (este expira al cabo de unos días, si quieren unirse y no pudieren pidan el nuevo en comentarios) Jugador Casual/Oliver de la Parra https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q --- Send in a voice message: https://podcasters.spotify.com/pod/show/master-phase/message Support this podcast: https://podcasters.spotify.com/pod/show/master-phase/support
In this episode, CardioNerds Dr. Daniel Ambinder, Dr. Giselle Suero Abreu, and Dr. Saahil Jumkhawala discuss thromboembolic disease in cardio-oncology with faculty expert Dr. Joshua Levenson, the Associate Program Director of the cardiology fellowship and an Assistant Professor of Medicine at the University of Pittsburg School of Medicine. Venous (VTE) and arterial thromboembolic (ATE) events are precipitants of morbidity and mortality in patients with cancer. Here, we discuss the pathophysiology of thromboembolism, risk factors and epidemiology for ATE and VTE, the role of risk prediction and patient stratification, and the approach to treatment for and prophylaxis of thromboembolic events with anticoagulation. Show notes were drafted by Dr. Saahil Jumkhawala and episode audio was edited by CardioNerds Intern Dr. Tina Reddy. This episode is supported by a grant from Pfizer Inc. This CardioNerds Cardio-Oncology series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Giselle Suero Abreu, Dr. Dinu Balanescu, and Dr. Teodora Donisan. CardioNerds Cardio-Oncology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Thromboembolic Disease in Cardio-oncology Patients with cancer are at higher risk of developing both arterial and venous thromboembolic events compared to the general population. Certain cancer subtypes are associated with a relatively higher risk of developing thromboembolic complications. Anticoagulation type and duration should be dependent on patient characteristics and risk factors, with shared decision-making between the patient and their providers. Subgroups of patients may benefit from more aggressive management of their atherosclerotic cardiovascular risk factors while being treated for cancer to reduce the risk of thromboembolic complications. Show notes - Thromboembolic Disease in Cardio-oncology What are the incidence and main manifestations of thromboembolic events (venous and arterial) in patients with active malignancy? Approximately 10% of outpatients with active cancer have venous thromboembolic events, many of which are asymptomatic. Clinically relevant VTEs are predominantly deep venous thrombosis (DVTs) with pain and/or swelling of the involved extremities or pulmonary emboli (PEs) resulting in chest pain and/or shortness of breath. VTE is the number one preventable cause of death for all hospitalized patients, and the ability to prevent and treat these events is crucial, particularly in high-risk populations such as patients with cancer. Are there any high-risk associations with specific cancer subtypes? Patients with metastatic disease and those receiving chemotherapy are more likely to develop arterial or venous thromboembolic events. Patients with acute myelogenous leukemia (AML) and thrombocytopenic patients are at the lowest risk for thromboembolic events. Multiple myeloma patients on medication such as proteasome inhibitors or lenalidomide appear at particular risk. Patients with localized, early-stage cancers such as breast, prostate, and melanoma are also at lower risk. What are the main risk factors to identify patients at a higher risk of developing thrombotic complications? Patients with a sedentary lifestyle, deconditioning, and undergoing active treatment with chemotherapy are at the highest risk of developing DVT or PE. How should we approach choosing the optimal type and duration of anticoagulation for acute pulmonary embolism (PE) in the setting of malignancy? This remains an area of active research. Historically, patients would receive systemic anticoagulation with heparin followed by warfarin.
NSAIDs have been shown to be associated with development of VTEs. This data is not new, but is more than 10 years old. Of course, hormonal contraception is also known to potentially increase the risk of VTE depending on the amount of estrogen in the combination product as well as the type of progestin used. So, a reasonable question to ask is whether the use of these two medications TOGETHER synergistically increase the risk of VTE. A recent publication in BMJ (06 Sept 2023) provided some controversial results in this very topic. Could those study results be the result of "indication bias" or protopathic bias? In this episode we will look at the data, summarize the key results, review the study limitations, and provide some real world clinical insights as to what to do with this new info.
En este capitulo hablamos de el mazo Tremere V5 que a nuestra opinión es un ejemplo de mazo toolbox, en esta ocasión nos acompaña un gran amigo desde Chile, Daniel Bravo "Backwinder" Escucha el podcast de nuestros amigos "El libro de Noob" directamente desde Chile. ¡acá el link! https://open.spotify.com/show/30COjBbUks4a4hbnTqpgXZ?si=15f1b92a0e6b401d Escucha el podcast de nuestros amigos "Bleed de 3" directamente desde España. ¡acá el link! https://open.spotify.com/show/2dot8G5KfmVuBnBPsyPoVd?si=cb569d96661f44af VtES México: https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Cuenta de El setita loco (mazos ganadores y finalistas) https://www.instagram.com/elsetitaloco/?hl=es La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://podcasters.spotify.com/pod/show/master-phase/support
Today's Speaker: Speaker: Oluseyi Abidoye, MD Objectives: - Review and understand the pathophysiology of VTEs in patients with traumatic fractures - Understand role of Antithrombotic agents in preventing VTEs in post-surgical patients - Review current guidelines of VTE prevention in patients with fractures - Understand the Role of Aspirin as a single agent for venous thrombophylaxis in patients after extremity fracture
En este Capitulo iniciamos nuestra 4ta temporada y que mejor hablando de política en el mundo de VtES. VtES México: https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Cuenta de El setita loco (mazos ganadores y finalistas) https://www.instagram.com/elsetitaloco/?hl=es Chile en Tinieblas https://www.instagram.com/chileentinieblas/?hl=es https://open.spotify.com/show/3CRtop1M5bbRoYrUK0kDwp?si=4ac88404bb4c4769 La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://podcasters.spotify.com/pod/show/master-phase/support
Join Prof Iain McInnes as he reviews two interesting papers. The first paper aimed to compare the risk of MACEs and VTEs for patients initiating a JAKinib (tofacitinib and baricitinib) and those initiating adalimumab (TNFi) among a large and comprehensive real-world population of patients with RA. Our second paper aimed to evaluate the efficacy and safety of FIL200 and FIL100 compared with placebo and ADA, all with background MTX, in patients with MTX-IR RA in subgroups of those with all four PPFs versus those with fewer than four PPFs. Everything discussed is available in a more detailed slide format in the publications section at cytokinesignalling.com.
On Episode 21 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the October 2022 issue of Stroke: “Oral Contraceptives, Hormone Replacement Therapy, and Stroke Risk” and “Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage.” She also interviews Dr. Shadi Yaghi about his article “Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis.” Dr. Negar Asdaghi: Let's start with some questions. 1) Do hormone replacement therapies or oral contraceptives increase the risk of stroke? And if yes, does the age of the individual or the duration of therapy modify this risk? 2) Should survivors of intracranial hemorrhage who have atrial fibrillation be treated with antithrombotic therapies for secondary prevention of stroke? 3) And finally, what is the anticoagulant of choice for treatment of cerebral venous sinus thrombosis? We have the answers and much more in today's podcast as we continue to bring you the latest in cerebrovascular disorders. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another amazing issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine, and your host for the monthly Stroke Alert Podcast. The October issue of Stroke covers a number of timely topics. As part of our October Literature Synopsis, we have a nice paper by Dr. Farida Sohrabji and colleague, which summarizes three recently published animal studies to evaluate the association between small vessel ischemic injury and either development of Parkinsonism or the future risk of Parkinson's disease. These studies looked at how ischemia, specifically involving the lenticulostriate arteries, can modulate the nigrostriatal dopaminergic pathway and ultimately lead to Parkinsonism. As part of our Original Contributions, we have the results of a small randomized trial out of Korea, which was led by Dr. Yun-Hee Kim from Sungkyunkwan University School of Medicine in Seoul, where we learned that doing 20 sessions of transcranial direct current stimulation for about 30 minutes for each session at home can improve post-stroke cognition. This was found to be specifically effective in patients with post-stroke moderate cognitive decline. Now, transcranial current stimulation can be given using a handheld device at home, and if truly proven safe and efficacious in larger studies, can dramatically change the landscape of stroke recovery in cognitive rehabilitation. I encourage you to review these articles in addition to listening to our podcast today. Later in the podcast, I have the great pleasure of interviewing Dr. Shadi Yaghi from Brown University. Shadi will walk us through a systematic review and meta-analysis of published studies to compare the safety and efficacy of direct oral anticoagulants to that of vitamin K antagonists in patients with cerebral venous sinus thrombosis. Our devoted Stroke Alert Podcast listeners recall that we did cover this topic in our March podcast when we reviewed the results of ACTION-CVT, a multicenter international study that was led by none other than Shadi himself. I'm delighted to have him as a guest on my podcast today to talk more about the seminal study and all things cerebral venous sinus thrombosis. But first, with these two articles. Millions of women worldwide use exogenous hormones, most commonly in the form of oral contraceptives and hormone replacement therapies. Despite the many different formulations of these drugs that are now available on the market, the two therapies are similar in that both combined oral contraceptives and hormone replacement therapies, or HRTs, contain various dosage of estrogen and progestin. Now, the principal difference between them being that the hormone contents of oral contraceptives are at high enough dosage to prevent ovulation, whereas hormone replacement therapies are considered more physiological as their aim is to return post-menopausal hormone levels to what they were before menopause. Well, by now, you must wonder how is any of this even relevant to vascular neurology? Well, the answer lies in the close relationship between hormonal therapies and stroke. But before we get to that, we have to review a few things. First of all, it's long been known that the endogenous estrogen has strong and protective effects on the arteries. It promotes vasodilation and cell survival of the endothelial layer. It increases the endothelial mitochondrial efficiency and stimulates angiogenesis. In other words, endogenous estrogen is good for vascular health. And in fact, that's why we think that premenopausal women, in general, are at a lower risk of stroke as compared to their age and vascular risk factors–matched male counterparts. And to make things even better for estrogen, there's enough evidence to suggest that exogenous estrogen also does all of these good things for the endothelium. So, why are we even talking about an increased risk of stroke associated with use of hormonal therapies? The problem is, we have to remember that exogenous estrogen also does other things. It can increase the blood concentration of procoagulants, which, in turn, can increase the risk of thromboembolism, especially venous thrombosis. But there's still a lot of unknown on this topic. For instance, the majority of the prior research on the topic involves postmenopausal women using hormonal therapies. Some of that research has actually suggested that HRTs may be protective against vascular events, while others showed the opposite. Well, we know that a majority of oral contraceptive users are actually much younger and use these medications premenopausal. So, there seems to be a lot of gaps in our current knowledge on the simple question of whether or not oral contraceptives and hormonal replacement therapies do, in fact, increase the risk of stroke or not. In the current issue of the journal, a group of researchers led by Drs. Therese Johansson, Torgny Karlsson, and Åsa Johansson from the Department of Immunology, Genetics and Pathology at Uppsala University in Sweden set out to fill some of these gaps with their study titled, "Oral Contraceptives, Hormone Replacement Therapy, and Risk of Stroke," as part of a large UK Biobank population-based cohort. Just a bit about the UK Biobank. This was a large population-based cohort from 2006 to 2010 that included over 500,000 residents of the United Kingdom between the ages of 37 and 73. Participants at the time of enrollment would have extensive information collected from them through questionnaires, interviews, health records, physical measures, as well as some imaging and biological samples. Data on each participant was collected from the time of their birth all the way to the day of assessment, which is interesting, because the day of assessment would then count as the end of the follow-up for each participant. Now, for the current study, they included over 250,000 women of White race in whom information required for the study on whether or not they use hormonal therapies, duration of treatment, age at the time of exposure was available. And just a quick comment about their methodology. They analyzed their cohort once for oral contraceptive use and once for HRT use and compared each group to a reference group of either women who never used their set therapy or the number of years they contributed to the study prior to initiating that set treatment. So, for instance, if a person started using oral contraceptives at the age of 21, all of the years that she contributed to the study before that age would count as non-exposed user years and were included in the control cohort. So now, on to their findings. A total of 3007 stroke diagnosis of any type were identified prior to the initial visit to the assessment center, which, as we mentioned, was the end of the follow-up in the study. Of these, 578 were ischemic strokes, 177 intracerebral hemorrhage, and 478 were subarachnoid hemorrhages. But as expected for any large cohort, over half of total strokes were self-reported as stroke of any type and could not be classified into any of the above subtypes. Now, let's look at the effects of oral contraceptives on the outcome of stroke. Overall of the women included in the study, 81% were classified as oral contraceptive users, while 19% reported never having used oral contraceptives at any point during the study. On the association between oral contraceptive use and the risk of stroke, at first glance, things looked OK. The hazard rates of any stroke for any stroke subtypes were not different between women who had used oral contraceptives as compared to those in the reference group. That's great news. But when they looked deeper, they realized that the odds of development of any stroke was actually quite high during the first year after the initiation of oral contraceptives with hazard rate of 2.49 for any stroke, while there was no difference in hazard rates found during the remaining years of use and after discontinuation of oral contraceptive use. So, meaning that there was no lingering effects of oral contraceptives on increased risk of stroke after the first year or after discontinuing the medication. Now, on to HRTs. In total, 37% of women in the study had initiated HRTs at some point during the study, while 63% had never used this therapy. Here's the bad news. Overall, HRTs did increase the risk of stroke. An approximately 20% increase event rate of any stroke was noted among women who had initiated HRTs as compared to those who had not. When analyzing stroke subtypes, the use of HRTs was associated with increased risk of only the subarachnoid hemorrhage subtypes. We don't know why. Diving deeper, in considering timing of HRT initiation, very similar to what was observed for the oral contraceptives, during the first year after starting the HRTs, the treatment group was twice more likely to suffer from any type of stroke, and the hazard rate was also increased for all three stroke subtypes that were available in the study. But, unlike oral contraceptives, the hazard rate of any stroke remains significantly high even after the first year of use, not just for those who continued HRTs, but sadly, even for those who discontinued the therapy. Though the risk remained high, the hazard ratio declined over time as we went further away from the first year when treatment was initiated. So, bottom line, if women had initiated HRTs at some point in their life, the hazard risk of any stroke increased significantly in the first year. That hazard risk did decline over time, but it always remained significantly higher than non–HRT users. Now, what about timing of treatment in relation to the onset of menopause? Is the risk of stroke any different if women start on HRTs prior to or after their menopause? The answer is no. Initiation of HRTs was associated with an increased hazard rate of any stroke if it was started pre- or postmenopausal, but the risks were higher if the treatment was started prior to menopause. So, in summary, this large population-based cohort has truly given us some very important practical findings. We learned that both oral contraceptives and hormone replacement therapies do, in fact, increase the risk of stroke, an effect that was most notable in this study in the first year after initiation of both of these therapies, and in the case of oral contraceptives, was just actually limited to that one year alone. Why does this happen? I guess the easy answer is that these drugs, as we noted earlier, have an immediate prothrombotic effect, which gradually weakens over time. That's one plausible explanation, but for instance, why HRTs increase the risk of subarachnoid hemorrhage is something we can't explain based on the prothrombotic effects of HRTs. So, we have to come back to the vessels, the impact of hormone therapies and estrogen specifically on the blood vessels, on the endothelial cells, the potential increase in blood pressure, especially early on in the course of treatment with these medications. And also, we have to think about the role these drugs may play in increasing inflammatory markers, providing a more suitable milieu for accelerated atherosclerosis, as to why these associations were noted in this study. And it's fair to say that we need more research on this topic in the future. One challenging scenario that we commonly face in our daily practice is deciding whether or not we should resume antithrombotics in patients with atrial fibrillation who have survived an intracranial hemorrhage. The majority of intracranial hemorrhage survivors with atrial fibrillation actually have a very high CHA2DS2-VASc score, which means that they are actually at a very high risk of future ischemic stroke and systemic embolic events unless they're treated with anticoagulants. On the other hand, the risk of spontaneous intracranial bleeding is substantially higher in a person who has previously suffered from one, let alone if we treat them with anticoagulants. And to make matters worse, we have little evidence from the literature to guide us. So, in the current issue of the journal, in the study titled "Effectiveness and Safety of Antithrombotic Medication in Patients With Atrial Fibrillation and Intracranial Hemorrhage," a group of researchers from the UK led by Dr. Deirdre Lane, Professor of Medicine at the University of Liverpool, performed a much needed systematic review and meta-analysis of the available evidence on this subject. I have to say that lately, it seems that we've been covering a few of these reviews in our podcasts, and we are just getting started. In fact, my next paper in today's episode is also a systematic review and meta-analysis. These papers are packed with details, a testament to the work needed to complete them, but I have to say that even summarizing these papers for a podcast has been a bit challenging. So, feel free to put me on pause, go get some coffee, and let's power through this one together. For their methods, they used the usual search engines looking for papers that included adults over the age of 18 with atrial fibrillation who had survived a non-traumatic spontaneous intracranial hemorrhage of any size, any type, and any location, be it lobar, brain stem, deep, cerebellar, subdural, epidural, or subarachnoid hemorrhage. And very importantly, they included even those with evidence of microbleeds on neuroimaging. The intervention of interest was either long-term oral anticoagulation or antiplatelet therapy versus no antithrombotic use for the following three outcomes of interest: number one, recurrent thromboembolic events; number two, recurrent intracranial hemorrhage; and number three, all-cause mortality. Just a quick note that for this analysis, they excluded studies that looked at either short-term anticoagulation or non-oral anticoagulation use for any reason that was given to the patient other than for secondary prevention of stroke. For example, if a patient suffered from a pulmonary embolism and was treated with IV heparin or, for a short period of time after that, with oral anticoagulation, those patients or those studies were excluded from this meta-analysis. So, with this criteria, they pulled over 4,000 citations and abstracts, and finally included 20 papers that were published between 2015 and 2021 for a total of over 50,000 participants for this meta-analysis, very nice sample size. Most of the papers included were observational cohorts, but in addition, we had two small randomized trials, and I want to take a moment and review these trials for our listeners. The first one was a small noninferiority pilot trial out of the UK, the SoSTART trial, that looked at any anticoagulant versus either antiplatelet therapy or no antithrombotics in this population, and the other trial was the Phase 2 trial, the APACHE-AF, that studied apixaban versus no anticoagulation after anticoagulant-associated intracerebral hemorrhage. A reminder that both of these trials were published in Lancet Neurology in 2021. And before we move on to the findings of the meta-analysis, it's worth noting that they had included a mix of patients, some were oral anticoagulant–naive, and some had developed their index intracranial hemorrhage while already on treatment with anticoagulants or antiplatelet therapies. OK, now on to their findings, as mentioned, we're going to review three outcomes of recurrent thromboembolism, recurrent intracranial hemorrhage, and all-cause death for the following three groups: group one, oral anticoagulant therapy versus no therapy; group two, oral anticoagulation therapy versus either antiplatelet treatment or no therapy; group three, comparing new oral anticoagulants versus warfarin. So, for the first outcome of recurrent thromboembolic events in group one, when comparing oral anticoagulant therapy to no therapy, the study showed a significant reduction in thromboembolic events in favor of oral anticoagulation compared to no therapy. That's great news. Next, analysis of the studies that compared oral anticoagulation versus either antiplatelets or no therapy didn't show the same difference in prevention of embolic events in favor of either groups. Actually, no difference was noted between the two groups. Number three, now, in terms of comparing NOACs to warfarin, three studies had the information on this comparison, and they reported a significant reduction in the risk of thromboembolic events with NOAC as compared to warfarin. So, great news for oral anticoagulation overall, and especially for NOACs. Now, on the next outcome. Our second outcome was a recurrent intracranial hemorrhage. Keeping in mind that they included some studies where the outcome was defined as any form of intracranial hemorrhage, meaning they included subdurals, epidurals, etc., and some studies only included the outcome of intracerebral hemorrhage. So, on to the first group, comparing oral anticoagulants to no therapy, the pooled estimate revealed no statistically significant difference between oral anticoagulant–treated patients to those who were not treated with any antithrombotics on the risk of recurrent intracranial hemorrhage. That's great news. Next, on our second group, for the same outcome of recurrent intracranial hemorrhage, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found that oral anticoagulation was associated with a higher risk of recurrent intracranial hemorrhage as compared to antiplatelets or no therapy. And finally, third group comparing new oral anticoagulants to warfarin for the same outcome, the risk of recurrent intracranial hemorrhage was significantly reduced in patients treated with NOACs as compared to warfarin. And now, we're finally on to our last outcome of the study, which is the outcome of all-cause mortality. So, again back to group one, comparing oral anticoagulants to no therapy, this meta-analysis showed a significant reduction in all-cause mortality rate associated with oral anticoagulation. That's, again, great news. Next group, for the same outcome of mortality, comparing oral anticoagulants to either antiplatelet therapy or no treatment, they found no significant difference in the mortality rates between the two groups. And finally, comparing NOACs to warfarin, the pooled estimate showed that NOACs were associated with a significantly reduced risk of all-cause mortality. Amazing news for NOACs. So, in summary, here's what we learned from this big study. Oral anticoagulation use after intracranial hemorrhage in patients with atrial fibrillation did significantly reduce the risk of thromboembolic events and all-cause mortality without significantly increasing the risk of recurrent intracranial hemorrhage. In general, new oral anticoagulants, or NOACs, are preferred to warfarin as they do prevent embolic events with a lower risk of recurrent intracranial hemorrhage. But, of course, we still have a lot more questions. For instance, would any of the outcomes mentioned above be different in patients with lobar intracerebral hemorrhage, a condition typically associated with amyloid angiopathy, which carries a high risk of development of intracerebral hemorrhage? Also, we have to keep in mind that the majority of the studies included in the meta-analysis were observational. So, there remains an urgent need for a larger randomized trial on this subject, and we have to stay tuned for more research. Cerebral venous sinus thrombosis, or CVST, is an uncommon form of stroke resulting in headaches, seizure, or focal neurological symptoms due to either intracranial hemorrhage or venous ischemic infarcts. The rarity of the disease has made it difficult to study as part of randomized trials, so current treatment guidelines for CVST are consensus-based with much of the recommendations extrapolated from data on treatment of patients with systemic deep vein thrombosis. In general, based on the current evidence, the field agrees that a patient with CVST should be anticoagulated. The decision that is difficult and sometimes inappropriately delayed in the setting of acute hemorrhage in the brain. And not surprisingly, there's significant equipoise around the choice of anticoagulant, duration of therapy, and the role of heroic therapies, especially in the acute setting. Currently, there are a number of ongoing trials to address some of these issues. The direct oral anticoagulants present an attractive alternative to vitamin K antagonists for treatment of patients with CVST. This is partly because of their convenience of use. But how do direct anticoagulants compare in safety and efficacy to the vitamin K antagonists in the setting of CVST is less known. In our March podcast, we reviewed the results of ACTION-CVT, which was a multicenter international study that compared the safety and efficacy profile of the direct oral anticoagulants to that of warfarin in routine practice. The study included over a thousand imaging-confirmed CVST patients from multiple centers in the US, Italy, Switzerland, and New Zealand. And if you missed it, no worries at all. We're here to review some of the results again, as in this issue of the journal, many of the ACTION-CVT investigators, led by Dr. Shadi Yaghi, present the results of a systematic review and meta-analysis comparing the safety and efficacy of DOACs, or direct oral anticoagulants, to that of vitamin K antagonists. I'm joined today by Dr. Yaghi himself to discuss ACTION-CVT and the current meta-analysis. Dr. Yaghi is a Director of Vascular Neurology at Lifespan and Co-Director of Comprehensive Stroke Center and a Director of Research at the Neurovascular Center at Rhode Island Hospital. Good afternoon, Shadi, and welcome to our podcast. Dr. Shadi Yaghi: Good afternoon, Dr. Asdaghi. Thank you so much for having me. Dr. Negar Asdaghi: Thank you. And please call me Negar. Congrats on the paper. Before we talk about the meta-analysis, can you please remind us of the results of ACTION-CVT and why the systematic review, in your opinion, was an important next step to that effort? Dr. Shadi Yaghi: Thank you so much for having me and for bringing up ACTION-CVT. So ACTION-CVT is a real-world multicenter international study that used real-world observational data to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The reason why we did ACTION-CVT was, as you know, cerebral venous thrombosis is a rare disease, and it's hard to have large studies that would be powered enough to compare the safety and efficacy of direct oral anticoagulants to vitamin K antagonists. So, most of the studies that were done are small, retrospective. There's one randomized controlled trial, but most of them are underpowered to detect the difference between the two groups. So, we decided to do a large-scale international multicenter study using real-world data to compare the safety and efficacy of both. Dr. Negar Asdaghi: OK, so we're glad you did. Let's start with the methodology of the current meta-analysis. Can you please give us an overview of the inclusion criteria for selection of the papers and the intervention and outcomes that you were interested in? Dr. Shadi Yaghi: Of course. So, this is a systematic review and meta-analysis that included studies comparing direct oral anticoagulants to vitamin K antagonists in patients with cerebral venous thrombosis. The studies needed to have the two groups included, the direct oral anticoagulants and vitamin K antagonists, and they need to include at least one of the outcomes in our study to compare this outcome between the two groups. In addition, we included articles published in English, and we also included papers that had five patients or more in each group. Dr. Negar Asdaghi: Perfect. So just recap for our listeners, in order to have been included in the meta-analysis, the paper had to have a reasonable number of patients, and you put that reasonable at the number five, and also they had to have at least one of the outcomes of interest reported in their papers. And those outcomes were either recurrent venous thromboembolism or recanalization rates. Right? Dr. Shadi Yaghi: Correct. Yes. Dr. Negar Asdaghi: Perfect. So with that, how many papers did you have to go through to come up with the current number of papers included? Dr. Shadi Yaghi: That's a great question. We had a little over 10,000 papers, and then we went through a screening process. We used this tool that was developed by Brown University. It's called Abstrackr, and what you do is, we did the search and using several databases like PubMed, Cochrane, and then we included all these studies. We uploaded them in Abstrackr, and Abstrackr was utilized to be able to review all these abstracts and select studies that may or will probably qualify and then go through the studies and details that would qualify. So, we had about 10,000 studies with the initial search, and we had two reviewers go through each abstract, and from these 10,665, we excluded 10,411, and that left us with 254 studies. And then we went through these 254 studies in details. And then finally, we had 19 studies included that met our inclusion/exclusion criteria. And these 19 studies included three randomized control trials and 16 observational studies. Dr. Negar Asdaghi: Incredible effort. So, three randomized trials in this meta-analysis and 16 observational studies. I think we're very ready to hear the primary outcomes. Dr. Shadi Yaghi: Yeah, so, the primary outcomes were recurrent venous thrombosis, and that included recurrent venous thromboembolism like peripheral DVTs or PEs, for example, and including recurrent cerebral venous thrombosis. And we know that most of the events are recurrent VTEs, not CVTs, like probably about two-thirds to three-quarters were VTEs, and a third to a quarter were CVT. And then the other efficacy outcome is venous recanalization on follow-up imaging. And we found that direct oral anticoagulants and warfarin were not significantly different in the primary efficacy outcomes. Dr. Negar Asdaghi: Thank you. I just want to repeat this for our listeners. So, you mentioned some important information here. First one was the fact that about three-quarters of recurrent events were actually systemic thromboembolic events rather than cerebral thromboembolism. So, an important outcome to keep in mind for our practicing physicians. And the fact that DOACs did the same as compared to vitamin K antagonist. So, I think you can already guess my next question, and that is, was there any compromise on the safety profile when using DOACs as compared to vitamin K antagonists in this meta-analysis? Dr. Shadi Yaghi: Thank you. That's a great question. In ACTION-CVT, we found that there was a lower risk of major hemorrhage with direct oral anticoagulants compared to vitamin K antagonists. In this systematic review and meta-analysis, we didn't find a significant difference, but there were fewer events in patients treated with direct oral anticoagulants versus vitamin K antagonists. This did not reach statistical significance, but if you look at the raw data, it's kind of along the same lines as ACTION-CVT, so the risk of major hemorrhage was about 3.5% with warfarin, and that was about 2% with direct oral anticoagulants. Dr. Negar Asdaghi: So, again, very important finding, and I want to repeat this for our listeners. So, important finding number one was that there was a superiority in favor of DOACs that you found in terms of a reduced risk of intracerebral hemorrhage in ACTION-CVT. You didn't find this superiority in the meta-analysis, but there was sort of a hint to perhaps lower risk of intracerebral hemorrhage in patients that were treated with DOACs. Did I get that right? Dr. Shadi Yaghi: Yes, that is correct, and in addition, also major hemorrhage in general, and that included also ICH. Dr. Negar Asdaghi: Oh, OK, so not just intracranial, but systemic hemorrhages as well. All right. Very good. So, I think my next question would be, why do you think that DOACs have a lower chance of causing hemorrhage? Dr. Shadi Yaghi: Yeah, that's a really good question. This is not unexpected with DOACs as opposed to vitamin K antagonists. We saw these same trends in patients with atrial fibrillation. We saw improved bleeding profiles with direct oral anticoagulants as compared to vitamin K antagonists. And the risks were along the same lines that we found in patients with cerebral venous thrombosis in ACTION-CVT. Also in the VTE trials as well, there was also reduced bleeding complications with direct oral anticoagulants as compared to vitamin K antagonists. So, it was kind of reassuring to see the same results in patients with cerebral venous thrombosis. Dr. Negar Asdaghi: Perfect, so kind of expected based on what we know from treatment of systemic conditions with DOACs. The next question I have for you is that in routine practice, treatment of cerebral venous sinus thrombosis almost always starts parenterally with either unfractionated heparin or low molecular weight heparin and then we switch to an oral agent. In the observational studies, did you find any differences in terms of timing of this switch or characteristics of the patients in whom vitamin K antagonists were chosen over direct oral anticoagulants? Dr. Shadi Yaghi: Thank you very much. Most of the studies did not report these details. I think the one study, off the top of my head, that does report the differences in characteristics between the two groups is RESPECT-CVT. That's the randomized controlled trial comparing dabigatran to vitamin K antagonists. In this study, there was a treatment with parenteral anticoagulation for several days, I think seven to 14 days, prior to transitioning to oral anticoagulation. And this is generally my practice. I typically would treat patients with at least seven days or so parenteral anticoagulation, and once they're clinically stable, then I would transition them to oral anticoagulation, either vitamin K antagonists or direct oral anticoagulant. Dr. Negar Asdaghi: And I think my next question is along the lines of this question as well. We have several direct oral anticoagulants now available on the market. What was the most common DOACs used for treatment of CVST in these studies, and did you note a preference for the use of any particular agent over others? Dr. Shadi Yaghi: Thank you so much for the question. Anti-Xa inhibitors were much more common than dabigatran, and the anti-Xa inhibitors most commonly used were apixaban and rivaroxaban. It's in line with what we saw in ACTION-CVT as well, although most of the randomized controlled trials or the largest randomized controlled trial, RESPECT-CVT, used dabigatran, but overall people have been using anti-Xa inhibitors, more particularly apixaban, which was also in line with what we saw in ACTION-CVT. Dr. Negar Asdaghi: But I think it's fair to say that we don't really have data on superiority of one over others. Is that fair? Dr. Shadi Yaghi: Yes, that is correct. Dr. Negar Asdaghi: OK, and so now, where are we at in terms of the future of studies on this topic? We have one ongoing randomized trial now? Dr. Shadi Yaghi: Yes, we have one randomized controlled trial ongoing, and this is the SECRET trial, and it's looking at rivaroxaban versus vitamin K antagonists in patients with cerebral venous thrombosis. There's another study, it's a prospective observational study that's called the DOAC-CVT study. It's an international study also looking at real-world data prospectively to see if there's a difference in outcomes between the two groups. Dr. Negar Asdaghi: So, we look forward to the results of those studies. Shadi, a follow-up question I have on this topic is, how long should a duration of therapy be in idiopathic cases of cerebral venous sinus thrombosis? Dr. Shadi Yaghi: Thank you so much for this question. So, it's unknown at this point for how long should we treat. The key things from the treatment are first achieving venous recanalization, and second is preventing another venous thromboembolic event from happening. So, regarding the venous recanalization, studies have shown that there's not a lot of recanalization beyond four months of treatment. So, a lot of the recanalization really happens early, and continuing anticoagulation beyond the six-months interval, for example, in order to achieve further venous recanalization probably has limited utility. And the second important reason why we treat patients with anticoagulation is also to reduce the risk of a recurrent venous thromboembolic event or cerebral venous thrombosis. And for that, if it's a provoked CVT, then I think usually it's three to six months. If it's unprovoked, up to maybe six to 12 months or even longer, depending on the profile. And if there's a persistent provoking factor, such as cancer, antiphospholipid antibody syndrome, then the treatment is lifelong or until this condition subsides. There's a lot of controversy about the duration of treatment. The European guidelines were very helpful in identifying the duration of treatment. Hopefully, also, we have some guidelines or at least a scientific statement by the AHA that also doles details out and provides some guidance to practitioners. Dr. Negar Asdaghi: Shadi, what should be our top two takeaways from the current meta-analysis and also ACTION-CVT? Dr. Shadi Yaghi: So, really, the top two from ACTION-CVT and the meta-analysis are, first is direct oral anticoagulants have a comparable efficacy to vitamin K antagonists in terms of recurrent venous thrombosis and achieving venous recanalization on follow-up imaging. And then the second point is direct oral anticoagulants are probably safer than vitamin K antagonists. We have to keep in mind that this data is based mostly on observational studies. And, as we mentioned earlier, we need more randomized controlled trials to support these findings. Dr. Negar Asdaghi: Dr. Shadi Yaghi, it was a pleasure interviewing you on the podcast. Thank you very much for joining us, and we look forward to having you back on the podcast and reviewing this topic again in the future. Dr. Shadi Yaghi: Thank you so much. I appreciate you having me. Dr. Negar Asdaghi: Thank you. And this concludes our podcast for the October 2022 issue of Stroke Please be sure to check out this month's table of contents for the full list of publications, including an important update from the European Stroke Organisation by Prof. Martin Dichgans. I also want to draw your attention to this month's InterSECT paper, which is our International Stroke Early Career and Training section, to discuss the key topic of burnout and mental health amongst physicians, especially amongst neurologists and stroke neurologists. It's alarming to read in this article that neurology is one of the specialties with the highest reported rates of burnout syndrome, and stroke neurologists are at particularly higher risk than other neurological subspecialties. The article tackles some tough subjects, such as the barriers for physicians to seek help and important strategies to mitigate burnout and how to improve mental health in general. I think it's also timely to know that October is the Mental Health Awareness Month, and the theme for October 2022 is "Back to Basics." The basics of recognizing the burden of stress, anxiety, the burden of isolation and depression, not only on those who we take care of, but also on those who give care to us. So, whether you're a stroke physician, a stroke caregiver, or whether you've been touched by this disease in some way or shape, please know that you are part of the stroke community and a part of our Stroke podcast family. Thank you for listening to us, and, as always, stay alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.
Many of us see things that need changing or improving nearly every day. Sadly, few of us take action to make those changes or improvements. Stefanie Perry, CVT, VTS (Dentistry) recognized that Arizona veterinary technicians didn't have an organization, so she and two others decided to make that change! This week, we learn how you can help the AZVTA and steps you can take to make changes in your world! Hosts Dr. Ernie Ward and Beckie Mossor, RVT are thrilled to introduce you to Stefanie Perry, CVT, VTS, the current President of the brand new Arizona Veterinary Technician Association (azvta.org). She's part of a growing movement of licensed veterinary technicians who are establishing protections and promoting better standards of veterinary care around the US. Regardless of where you live, this episode is both inspiring and pragmatic for making change. We need more folks like Stefanie, President-Elect Jennifer Serling, CVT, RVT, VTES, AAS, BVSc (Go App State!), and Vice President Katie Foust, CVT! Bravo! If you're interested in learning more about the AZVTA, visit them at azvta.org.
En este capitulo hablamos de tematica Red List en VtES, continuamos con la libreria. Escucha el podcast de nuestros amigos "Bleed de 3" directamente desde España. ¡acá el link! https://open.spotify.com/show/2dot8G5KfmVuBnBPsyPoVd?si=cb569d96661f44af VtES México: https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Cuenta de El setita loco (mazos ganadores y finalistas) https://www.instagram.com/elsetitaloco/?hl=es Chile en Tinieblas https://www.instagram.com/chileentinieblas/?hl=es https://open.spotify.com/show/3CRtop1M5bbRoYrUK0kDwp?si=4ac88404bb4c4769 La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://anchor.fm/master-phase/support
En este capitulo hablamos de tematica Red List en VtES, empezamos por la cripta. Escucha el podcast de nuestros amigos "Bleed de 3" directamente desde España. ¡acá el link! https://open.spotify.com/show/2dot8G5KfmVuBnBPsyPoVd?si=cb569d96661f44af VtES México: https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Cuenta de El setita loco (mazos ganadores y finalistas) https://www.instagram.com/elsetitaloco/?hl=es Chile en Tinieblas https://www.instagram.com/chileentinieblas/?hl=es https://open.spotify.com/show/3CRtop1M5bbRoYrUK0kDwp?si=4ac88404bb4c4769 La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://anchor.fm/master-phase/support
This time Rands is joined by one of the most prolific collectible trading card game designers of all time—Paul Peterson.Paul tells us how he rose from Customer Service at Wizards of the Coast to become their go-to "TCG guy" during that company's most active period in the TCG space. All tallied, Paul has worked on more than a dozen collectible games throughout his career & we try to hit as many as we can during this chat.So sit back & get ready to be transported back to the TCG-heyday of the 1990s!Find Smash-Up via AEG:https://www.alderac.com/smash-up-home/Follow Paul on twitter:https://twitter.com/warewolf00/~SPONSOR~:https://www.categoryonegames.com/(find classic CCG & TCG cards at Category One Games!!!)THE BOOSTER PACK—let us know feedback, topic suggestions or games you'd like to hear about via email or any of our social media (DMs are also open to anyone)Find CCG History:https://www.facebook.com/CCGhistoryhttps://twitter.com/CCGHistoryThis show is also available on video. Find the episodes via youtube.com/CCGhistory.The listener survey for The Booster Pack podcast:https://www.surveymonkey.com/r/ZG95TR9or, email us—theboosterpack@ccghistory.com[Music Credit: The Crypts — Rockin' Roman]
On this episode, Rands is joined by L Scott Johnson... or LSJ as he is known to "Vampire: The Eternal Struggle" players around the world.LSJ is an instrumental figure in the history of VtES & here we explore his journey from a self-proclaimed “rulemonger” on early USENET groups to ambassador of the game to becoming its lead designer when the CCG was printed by White Wolf Publishing.So retire to your crypt, draw the shades & sink your teeth into this trip back through Vampire: The Eternal Struggle's past.FABLEGRAPH (LSJ's Photography)https://www.facebook.com/fablegraph/https://www.instagram.com/fablegraph/https://fablegraph.com/BINDUSARA JYHAD DIARY (Blog — Oral history interviews of VtES)https://bindusara.home.blog/VEKN (Vampire Elder Kindred Network, Player organization)https://www.vekn.net/https://www.facebook.com/vampiretheeternalstruggle/BLACK CHANDRY - publisher of brand new VtES products:https://www.blackchantry.com/~SPONSOR~:https://www.categoryonegames.com/(find classic CCGs / TCGs at Category One Games!!!)THE BOOSTER PACK—let us know feedback, topic suggestions or games you'd like to hear about via email or any of our social media (DMs are also open to anyone)Find CCG History:https://www.facebook.com/CCGhistoryhttps://twitter.com/CCGHistoryThese videos too long? The audio version of this podcast might work better for you:https://pod.link/1553640008The brand-new listener survey for The Booster Pack podcast:https://www.surveymonkey.com/r/ZG95TR9or, email us—theboosterpack@ccghistory.com[Music Credit: The Crypts — Rockin' Roman]**very appropriately named band for THIS episod
An interview with Dr. Pauline Funchain from Cleveland Clinic, author on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” She reviews the recommendations for cardiovascular toxicities in patients receiving ICPis, including overall cardiac toxicities (i.e., myocarditis, pericarditis & arrhythmias), and VTE in Part 11 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines TRANSCRIPT SPEAKER 1: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today we're continuing our series on the management of immune related adverse events. I am joined by Dr. Pauline Fontaine from the Cleveland Clinic in Cleveland, Ohio, author on "Management of Immune Related Adverse Events in Patients Treated with Immune Checkpoint Inhibitor Therapy, ASCO Guideline Update," and Management of Immune Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T Cell Therapy, ASCO Guideline." And today we're focusing on the cardiovascular toxicities in patients treated with immune checkpoint inhibitor therapy. Thank you for being here, Dr. Fontaine. PAULINE FONTAINE: Thank you, Brittany, for the invitation. BRITTANY HARVEY: First, I'd like to note that ASCO takes great care in the development of its guidelines, and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Fontaine, do you have any relevant disclosures that are directly related to these guidelines? PAULINE FONTAINE: So I do. My institution receives research funding from Pfizer and Bristol Myers Squibb for clinical trials where I'm a primary investigator. And I have done some consultation work with Eisai. BRITTANY HARVEY: OK. thank you for those disclosures. Then talking about the content of this guideline, what are the immune related cardiovascular toxicities addressed in this guideline? PAULINE FONTAINE: So there are two major categories. One is an overall cardiovascular category. That includes myocarditis, pericarditis, arrhythmias, impaired ventricular function with heart failure, and vasculitis. That's overall. And there's a second category of venous thromboembolism. BRITTANY HARVEY: Great. Then starting with that overall category, what are the key recommendations for identification, evaluation, and management of myocarditis, pericarditis, arrhythmias, impaired ventricular function with heart failure, and vasculitis? PAULINE FONTAINE: So in that overall category, I think it's important to recognize that there are symptoms that are a little bit more general. They may be cardiovascular. They may be pulmonary. But we have to be aware that some of these can be cardiovascular. So that would include worsening fatigue, progressive or acute dyspnea. I think they're generally going to be other things, but you really have to recognize a potential cardiac IRE, as those can have major medical consequences. I mean there are other things that are more obviously cardiac, like chest pain, arrhythmia, palpitations, acute onset peripheral edema. And it is important to note that they can, like every other IRE, happen at any time. In the literature, the median time to onset is 6 weeks, but the range is somewhere between 1.4 to 54, and we know that it can be all over the place with IREs in terms of presentation. Then next would be evaluation. So with evaluation, whenever you see this type of side effect, fatigue, dyspnea, chest pain, it's natural to want to get an EKG troponin. I think that's a great place to start. And I think if there's more concern for cardiac type of IRE, then an echocardiogram, a chest X-ray, I think, are probably the next easiest evaluations to assess for cardiac IRE. One of the important things to note is that cardiac IREs, especially myocarditis, tend to happen along with concurrent myocytis, so it's important to check a CPK to rule that in or rule that out. And typically, then if people need more evaluation, the cardiac MRI is the next step, but things like cardiac catheterization may be involved. And so that's where I think it's really important with management to have cardiology involved early. I mentioned this briefly before, but it's really important to know that myocarditis has a very high fatality rate, up to about 50% in published series. I think as we get better at recognizing myocarditis, that fatality rate will likely go down, but catching a cardiac IRE late can have some very serious implications for our patients. So immediately recognizing that a cardiac workup is necessary, and referring early to cardiology is really important, no matter what grade of cardiac IRE we see. And I do think that with cardiac IREs, it's really, is it an inpatient workup? Does it require immediate cardiac consultation and workup? If there are elevated troponins that are going up, or conduction abnormalities, does that patient need to be in a cardiac unit? I think those are the major things to keep in mind with management. Another thing, I think, that is really important because of the high fatality rate: starting corticosteroids early. So like our other IREs, you can start corticosteroids that 1 to 2 mgs per kg per day. And doing that early has the potential to quickly improve cardiac inflammation, keep people from the very serious and potentially fatal side effects for cardiac IREs. And it really doesn't have that much of a consequence in the short term. So I think in discussions about this guideline, we all felt that if a patient has a Grade 2 or higher IRE-- so that's anything that has a cardiac biomarker that's abnormal plus symptoms of any kind-- it's important to keep in mind early steroids and early cardiac consultation. For very, very severe cases where management with corticosteroids is not improving the patient's status, then we highly recommend considering cardiac transplant rejection doses, which would be methyl pred at 1 gram daily, or adding other immunosuppressants. So there are not as many studies as we would like, but mycophenolate, infliximab, antithymocyte globulin have all been reported. There have also been case reports on abatacept or alemtuzumab, with good outcomes. So those are things to consider, of course, with cardiology input for severe cases. BRITTANY HARVEY: Thank you. Those are important notes for clinicians to keep in mind for management and evaluation. So then, the second category that you mentioned, what are the key recommendations for identification, evaluation, and management of venous thromboembolism? PAULINE FONTAINE: So for identification, most everyone listening to this podcast knows what a venous thromboembolism looks like. That's extremity swelling, extremity pain, sometimes accompanied by fever, pleuritic pain, cough, dyspnea. And the evaluation is the same as what you would see in clinic. That would be venous ultrasounds for any suspected deep vein thromboembolisms. And CT, PE for any suspected pulmonary embolism. And of course, a VQ scan if you can't do that type of CT. And the management is the same as what you would normally do in clinic. So if it's a superficial thrombosis, that would be a grade 1. You would do a warm compress, do supportive care. But importantly, you can continue the immune checkpoint inhibitor per our recommendations. For grade 2, so a symptomatic thrombosis, a deep vein thrombosis, that would require anticoagulation. But again, once anticoagulation has been started, the recommendation is that it is safe to continue the immune checkpoint inhibitor therapy, because at this point, you're protected. Should be, in theory, protected from future embolic events. And then, I think the major thing is that for management in general once there is anticoagulation on board, then there isn't necessarily a reason to hold immune checkpoint inhibitor therapy. I think that the major reasons we would recommend to hold it are life threatening consequences, organ damage. So grade 4 embolic event, where you would have to admit the patient. And then it becomes a risk benefit discussion after an admission. In general, I think the recognition and treatment are the same in terms of venous thromboemboli that are identified in the context of immune checkpoint inhibitor therapy. The major thing is just to know that it exists as a potential side effect, that the incidences appear to be higher, and that there is something about immune checkpoint inhibitor therapy that may put our patients at higher risk for these embolic events. BRITTANY HARVEY: Definitely. That's key to know, and particularly also when to hold or continue ICPI therapy. So then in your view, Dr. Fontaine, how will these recommendations for management of cardiovascular toxicities impact both clinicians and patients? PAULINE FONTAINE: I think the major thing is to know that these exist. The overall cardiac toxicities are less common, so if we're talking about myocarditis, that is a pretty rare event. But it's important to know that this is an event that is potentially fatal, that that fatality happens often, and that myocarditis can occur along with a myositis, and in some cases with myasthenia gravis. So these are three different rare side effects that can happen together, sometimes in pairs, sometimes in triplets, sometimes just one of them. But any one of these three has a higher risk for fatality. So I think just to know that it's out there. So that that is just hanging around in the differential for someone who is tired or out of breath. It may be pulmonary, but also keep in mind that it could be cardiac, and that is serious, and that should be worked up early and treated early. I think that's the major thing that I hope these guidelines do, is put these important but rare side effects out there and potentially save lives. I will say for VTEs, for venous thromboemboli, again, so PE can happen, and it can be fatal. I think this is not as rare, but of course, it's not rare in our patient population either. So these are things that we already look out for. Just, I think, if this podcast and the guidelines can add to the education that immune checkpoint inhibitors will increase the risk of thromboembolism, I think that those are the important takeaways. BRITTANY HARVEY: Absolutely. Recognition of these IREs is a common theme across the affected organ sites that we've heard in many of these podcast episodes. So I want to thank you for your work on these guidelines and for taking the time to speak with me today, Dr. Fontaine. PAULINE FONTAINE: Thank you for having me. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. Stay tuned for additional episodes on the management of immune related adverse events. To read the full guideline, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in iTunes or the Google Play store. If you've enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.
En este Capitulo continuamos con las disciplinas, hablamos de Taumaturgia y sus cartas mas relevantes. VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ Chile en Tinieblas https://www.instagram.com/chileentinieblas/?hl=es https://open.spotify.com/show/3CRtop1M5bbRoYrUK0kDwp?si=4ac88404bb4c4769 La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://anchor.fm/master-phase/support
En este Capitulo continuamos con las disciplinas ,hablamos de Striga y Maleficia que en VtES no se consideran disciplinas como tal, hablamos de todas sus cartas. VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Lalo https://www.instagram.com/lalovtes/ Luis https://www.instagram.com/luisjimenez6869/ Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ La voz de las menciones y cortinillas es de Pammy West. Datos de contacto: https://www.instagram.com/pammywest/ Correo: pammywest@icloud.con --- Support this podcast: https://anchor.fm/master-phase/support
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ --- Support this podcast: https://anchor.fm/vtes-mexico/support
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ --- Support this podcast: https://anchor.fm/vtes-mexico/support
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ --- Support this podcast: https://anchor.fm/vtes-mexico/support
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ --- Support this podcast: https://anchor.fm/vtes-mexico/support
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/ --- Support this podcast: https://anchor.fm/vtes-mexico/support
Adrian is joined by Hugh Angseesing of Black Chantry Productions to chat about Vampire: the Eternal Struggle Fifth Edition. An overview of the game is provided, including strategies and deck types, as well as the features that differentiate V:tES from other CCGs. Finally, Hugh answers questions about the alignment between V:tES and Vampire: the Masquerade Fifth Edition, what this means for existing players, and how the game aims to be more inclusive and representative. We finish off with some of our favourite flavour text from the game. I've linked out to Black Chantry Productions, the Print-on-Demand Card Service, Andi Lui (Prince of Taipei), and the V:TES Fifth Edition Starter as mentioned in the episode. Since recording, Black Chantry have uploaded the new V:tES rulebook for free download. Host: Adrian BK
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
La Linea de Sangre en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT https://www.youtube.com/channel/UCBhZefZH7kIpDPkXuh4SKbQ Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night https://www.youtube.com/channel/UCBCkwBOAd2Hy8CS9_buJitg Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
En esta ocasión hablamos del Sabbat, La Mano Negra(Black Hand) y sus cartas dedicadas. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
En esta ocasión hablamos de la poderosa Camarilla y sus cartas dedicadas. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
Contents:Patron Questions"Tzimisce on Humanity""Antediluvians in chronicles""Inexperienced political players and how to help them""Players in LARP looking to ruin everyone else's fun, advice"This week on Curse of Caine insights:"Humanity From a player perspective""In game Consequences Vs Player Fun""Pack Bonding in and out of character for Sabbat"News Vampire The Masquerade Shadows of New York Gameplay Trailer Vampire the Masquerade Rivals Kickstarter August 4th: (2-4 player expandable card game that has light elements familiar for folks who have played VTES) https://www.renegadegamestudios.com/news/2020/7/14/vampire-the-masquerade-rivals-expandable-card-game-kickstarterSupport the show (https://www.patreon.com/25yearsofvampirethemasquerade/posts)
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
El clan en el juego de cartas y su relación con el rol, Disciplinas, Vampiros, y Decks. Nuestras redes sociales: VtES México https://www.facebook.com/vtesmexico/ https://www.instagram.com/vtesmexico/ https://twitter.com/vtesmexico https://discord.com/invite/HXh2xhT Jugador Casual/Oliver de la Parra https://www.facebook.com/oliverjugadorcasual/ https://www.instagram.com/jugador.casual/ Podcast Jugador Casual https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy?si=oTVwEy_zRWeUfFB5fc4vWg Juarez by Night/Eidan Rodriguez https://www.facebook.com/juarez.by.night/ https://www.instagram.com/juarez.by.night/ https://twitter.com/juarez_by_night Podcast Juarez by Night https://open.spotify.com/show/4yIVhNJnCTalkOuRFEwTUx?si=jCuUXiwBT-WhK3m9vnFY0Q Luis https://www.instagram.com/luisjimenez6869/ Venta de VtES en México en el Club Juegos de Mesa https://www.facebook.com/Elclubjuegosdemesa/ https://www.instagram.com/el_club_juegos/
En este episodio hablamos de Quimerismo, la disciplina distintiva del Clan Ravnos Sus posibles orígenes y su relación con la Senda de la Paradoja.Sus niveles básicos y aplicaciones de los mismos.Sus variados niveles superiores.Nuestro Canal de Discord: https://discord.gg/k39sEzANuestros patrocinadores:Vaping Jrz: https://www.facebook.com/VapingJRZ/Oliver de la Parra, el Jugador Causal está en: https://www.facebook.com/oliverjugadorcasual/ https://www.youtube.com/channel/UCW264O8WM1sJwj2yqUdqIzQ https://open.spotify.com/show/4CpeDuA2sk1KxNBQul8fIy https://www.instagram.com/jugador.casual/Vlad:https://www.instagram.com/antlered_head/Gelial: www.twitch.tv/gelialtron www.facebook.com/GelialGamingEdgar Meritano:https://www.instagram.com/emeritano/ https://www.flickr.com/photos/emeritano/https://twitter.com/emeritanoOdile Clio:https://twitter.com/OdileCliohttps://www.instagram.com/odileclio/Nuestro amigos:El Gremio de la Frontera: https://www.facebook.com/groups/443096336234894/Ones for all Roleplay: https://www.instagram.com/ones_for_all_roleplay/Shire Filaments: https://www.instagram.com/shire_filaments/Master Phase: https://open.spotify.com/show/64fwdiaY5eivxzS5qZDYyfJose Antonio Badia: https://twitter.com/ElBadiablo https://www.instagram.com/elbadiablo/El Dollop: https://www.youtube.com/channel/UCgtRDZyErd_QQwnclSyyo4Ahttps://open.spotify.com/show/5o5VNgyXWpa1161ppev6mlhttps://twitter.com/eldollop?lang=enhttps://www.instagram.com/eldollop/Leyendas Legendarias:https://www.youtube.com/channel/UCugC9R-gE-6mgUgIqNy387Q/featuredhttps://open.spotify.com/show/6wF969GfLUfypoKaicH5grhttps://twitter.com/leyendaspodcast?lang=enhttps://www.instagram.com/leyendaspodcast/?hl=enRecuerden que pueden contactarnos con comentarios, sugerencias y preguntas a juarez.by.night@gmail.com y seguirnos en https://www.instagram.com/juarez.by.night/ y en https://www.facebook.com/juarez.by.night/ para conocer más de Juárez by Night y noticias sobre Vampiro la Mascarada.Y si tienen algún evento, grupo o mesa de juego que gusten publicitar con mucho gusto los mencionaremos en el programa.Algunas partes de los materiales son derechos de autor y marcas registradas de Paradox Interactive AB, y se usan con permiso. Todos los derechos reservados. Para obtener más información, visite white-wolf.comEste programa no forma parte del material oficial del Mundo de Tinieblas de White Wolf.Música de Fondo: La Ley - Mentira, del álbum "MTv Unplugged" (2001)
Join Claressa Monteiro, as she speaks to Associate Professor Lee Lai Heng, Haematologist, Singapore General Hospital about VTEs, the eThrombosis condition, the risks of not promptly treating it and the ways in which we can avoid getting struck by VTEs altogether.
Brendan discusses the five games he own by prominent designer Richard Garfield (best known for Magic: The Gathering). Games mentioned: Magic: The Gathering Roborally King of Tokyo Vampire: The Eternal Struggle Bunny Kingdom Android: Netrunner What are your favorite Garfield games? Stop by our guild #3269 and let us know!
Brendan discusses the five games he own by prominent designer Richard Garfield (best known for Magic: The Gathering). Games mentioned: Magic: The Gathering Roborally King of Tokyo Vampire: The Eternal Struggle Bunny Kingdom Android: Netrunner What are your favorite Garfield games? Stop by our guild #3269 and let us know!
Brendan discusses the five games he own by prominent designer Richard Garfield (best known for Magic: The Gathering).Games mentioned:Magic: The GatheringRoborallyKing of TokyoVampire: The Eternal StruggleBunny KingdomAndroid: NetrunnerWhat are your favorite Garfield games? Stop by our guild #3269 and let us know!
Brendan discusses the five games he own by prominent designer Richard Garfield (best known for Magic: The Gathering).Games mentioned:Magic: The GatheringRoborallyKing of TokyoVampire: The Eternal StruggleBunny KingdomAndroid: NetrunnerWhat are your favorite Garfield games? Stop by our guild #3269 and let us know!
Mike is joined by Adrian of the Mirage Arcana Podcast for the last Darker Days of 2010. The two discuss a lot of what's going on with the Wild Games Productions Radio Network and shed some light on the new White Wolf print and digital products. They discuss the North American Championship for VtES and the Grand Masquerade in general. Original World of Darkness: Adrian talks about his favorite Vampire supplement, The Last Supper. The hosts discuss the story's strengths and give tips on how to run it. New World of Darkness: Mike leads the discussion of how to use themes and concepts from The Last Supper for Promethean, Changeling, Hunter, and Geist - giving some love to the limited lines. Adrian also comes up with the idea of World of Darkness: Die Hard Edition. Darker Days is also looking for one or two more hosts, so if you're interested post in the Darker Days Episode 21 Thread here: http://www.wildgamesproductions.com/viewtopic.php?f=5&t=767 Skype: lost_heretic www.darkerdays.tk www.wildgamesproductions.com
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