Taming the Bleed: An Algorithm for Action - Deborah Siegal & Siraj Mithoowani

Send us a textDrs. Mithoowani and Siegal discuss new expert guidance for managing severe bleeding in patients taking oral anticoagulants, including identifying those at risk, optimizing supportive measures, treating the source of bleeding, and administering reversal agents. It includes discussion of the algorithm for use at the point of care that helps identify patients at risk of adverse outcomes, optimize supportive measures, treat the source of bleeding, and administer anticoagulant reversal or hemostatic therapies.Abstract: http://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2464-2887 Full text HTML: http://www.thieme-connect.com/products/ejournals/html/10.1055/a-2464-2887 Full text PDF: http://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-2464-2887.pdf Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

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

Send us a textAn insightful conversation with co-authors Dr Thalia Field and Dr Jennifer Mandzia on the Canadian Stroke Best Practices 7th edition, Cerebral Vein Thrombosis. Hear from two of the guideline's authors about the latest recommendations on management of CVT.For a copy of the publication click here: Publication LinkSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a textDr Deborah Siegal joins us for a discussion on the recent paper, The Efficacy and Safety of Andexanet Alfa in Patients With Acute Gastrointestinal Bleeding While Taking Factor Xa Inhibitors: An ANNEXA-4 Sub-analysis. In this wide-ranging discussion she reviews the results of the sub-analysis and the need for anticoagulant reversal for acute GI bleeding. This discussion provides her perspective on the issue of bleeding with DOACs and the challenges in patient management.Dr. Deborah Siegal MD MSc FRCPC is a clinician-scientist hematologist (thrombosis medicine) at The Ottawa Hospital, Associate Professor of Medicine and School of Epidemiology and Public Health at the University of Ottawa, and Scientist at the Ottawa Hospital Research Institute.  Her primary research interest is improving the safety of anticoagulant therapy including optimizing the management of anticoagulant-related bleeding complications, restarting anticoagulants after bleeding, perioperative management of anticoagulants, and antithrombotic therapies for ischemic stroke in patients with cancer. Dr Siegal is a member of the board of directors of Thrombosis Canada. Reference:Siegal DM, Forbes N, Eikelboom J, Beyer-Westendorf J, Cohen AT, Xu L, Connolly SJ, Crowther M. The Efficacy and Safety of Andexanet Alfa in Patients With Acute Gastrointestinal Bleeding While Taking Factor Xa Inhibitors: An ANNEXA-4 Subanalysis. Circulation. 2024 Apr 16;149(16):1315-8.https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.123.066933Follow us on Twitter:@ThrombosisCan@debsiegalSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a textThis episode of CLOT Conversations features Dr Sam Schulman (Hamilton) and Dr Michelle Sholzberg (Toronto) discussing the 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19 of which they were two of the co-authors.While COVID-19 is no longer considered a global emergency, healthcare professionals continue to see critical and non-critical cases regularly. This is particularly the case in locations where medical care is challenging.There was a need to update the 2022 guidelines due to the large number of recently-published studies in the area that were not included in the 2022 edition. Consideration was given to recommendations that could be implemented globally. This is an important update to take into account when encountering patients with sever COVID illness.Reference:Schulman S, Arnold DM, Bradbury CA, Broxmeyer L, Connors JM, Falanga A, Iba T, Kaatz S, Levy JH, Middeldorp S, Minichiello T. 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19. Journal of thrombosis and haemostasis. 2024 Mar 18.Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a textThis podcast episode features Dr. Barbara Gunka and Dr. Siraj Mithoowani discussing their research on how bariatric surgery affects direct oral anticoagulants (DOACs).Bariatric surgery is increasingly used to fight obesity-related health problems. However, these patients often need DOACs to prevent blood clots due to surgery and obesity.The concern is that bariatric surgery might change how the body absorbs DOACs. This could make the medications less effective. There's limited data on long-term DOAC use after bariatric surgery.Dr. Gunka and Dr. Mithoowani's study investigated DOAC levels in patients after bariatric surgery. They looked at patients who received any type of bariatric surgery, took a DOAC for any reason, and had their DOAC levels measured afterwards.Tune in to hear the full discussion about the study's findings and their implications for DOAC use after bariatric surgery.Reference:Gunka, B., Mackenzie, D., Hughes, T., Sardo, L., Bayadinova, J., Siegal, D. M., ... & Mithoowani, S. (2024). Pharmacokinetics of direct oral anticoagulants after bariatric surgery: A retrospective cohort study. Thrombosis Research, 235, 15-17.Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a textThis podcast features an interview with Laurie Sardo and Julia Bayadinova, experts on Cancer-associated Thrombosis, from Hamilton Ontario, authors of a series of publications in the Canadian Oncology Nursing Journal on Cancer-associated Thrombosis, called Spot the Clot.Laurie Sardo is a Nurse Practitioner in the Thrombosis Service, Department of Hematology at St. Joseph's Healthcare in Hamilton. She graduated with her NP from McMaster University in 2014, and her Doctorate in Nursing Practice from D'Youville University in 2022. Laurie’s thesis work focused on patient VTE education in the high-risk cancer population.Her professional interests include patient and staff education and remains active on a number of educational interest groups including the Thrombosis Canada Patient & Family Education committee, the ISTH Nursing committee and the US-based Anticoagulation Forum.ANDJulia Bayadinova, is a nurse practitioner specializing in Thromboembolism, serving both inpatients and outpatients at St. Joseph’s Healthcare Hamilton. In 2014, Julia graduated from Ryerson University with a combined Master of Nursing and Primary Care Nurse Practitioner Program, and has since found her passion in Thromboembolism. Her research interest lies in patient education. Julia is currently in pursuit of a Doctorate of Nursing Practice degree at Post University and is completing a thesis on the importance of patient education.In this episode, the two guests review some of the key take-aways from the series of articles. The articles can be accessed here:CAT Series in Canadian Oncology Nursing Journal:The significance of VTE in cancer: Introduction of the ‘Spot the CLOT’ serieshttps://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1234Spot the CLOT’: What cancer patients want to know https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1262Spot the CLOT’: Awareness of cancer-associated thrombosis in healthcare providershttps://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1277/1067Spot the CLOT: Treatment considerations for CAThttps://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1372Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a textIn Season 2, Episode 2 of CLOT Conversations from Thrombosis Canada, Dr. Tzu-Fei Wang, an associate professor and hematologist, discusses a recent study titled "The prevalence of relevant drug-drug interactions and associated clinical outcomes in patients with cancer-associated thrombosis on concurrent anticoagulation and anticancer or supportive care therapies." The study aimed to investigate drug-drug interactions (DDIs) between anticoagulants and other medications in cancer patients and their impact on clinical outcomes.High Risk of DDIs: The study found that approximately 41% of cancer patients on anticoagulation therapy had relevant drug-drug interactions, particularly with antidepressants and certain other medications.Overall, the study highlights the importance of assessing and managing drug-drug interactions in cancer patients receiving anticoagulation therapy, while also suggesting that not all DDIs necessarily lead to adverse clinical outcomes. Collaborative efforts and larger data sets are needed to better understand and address this complex issue.Reference: Wang TF, Hill M, Mallick R, Chaudry H, Unachukwu U, Delluc A, Carrier M. The prevalence of relevant drug-drug interactions and associated clinical outcomes in patients with cancer-associated thrombosis on concurrent anticoagulation and anticancer or supportive care therapies. Thrombosis Research. 2023 Nov 1;231:128-34.  https://www.sciencedirect.com/science/article/pii/S0049384823002815 Support the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a textThe CLOT Conversation Hosts (Dr Jameel Abdulrehman and Dr Maha Othman) discuss Post-Thrombotic Syndrome and the TILE study with two of the authors of the recently published paper, Tinzaparin Lead-in to Prevent the Post-Thrombotic syndrome study protocol, Dr Jean-Phillippe Galanaud and Dr Ilia Makedonov. In the interview the authors discuss the latest research on PTS and the rationale for the TILE study.Dr Jean-Philippe Galanaud is a General Internal Medicine specialist and Thrombosis Physician. He works as a staff physician in the Department of Medicine at Sunnybrook Health Sciences Centre in Toronto; He is associate Professor of Medicine at the University of Toronto.His areas of expertise in research are in the field of the post thrombotic syndrome and of distal DVT; He is currently conducting, with Susan Kahn from McGill, 2 multicentre studies in the field of PTS; 1 on the prevention of post thrombotic syndrome with LMWH (The Tile study) and 1 on the treatment of post thrombotic syndrome with venoactive drugs (The MUFFIN study)AndDr Makedonov completed medical school at the University of Toronto, followed by internal medicine residency in Ottawa. He took a keen interest in thrombosis, doing a fellowship at Sunnybrook and receiving a grant from CanVECTOR. He research has focused on the post thrombotic syndrome as well as distal DVT and cerebral venous sinus thrombosis. He runs a thrombosis clinic at the Southlake Regional Health Centre. He has a broad clinical practice, including peri-partum and cancer associated VTE. In his spare time , he bikes and sails. He hopes to one day own a dog. Reference:  Makedonov I, Kahn S, Abdulrehman J, et al. TILE pilot trial study protocol: Tinzaparin Lead-in to Prevent the Post-Thrombotic syndrome study protocol. BMJ Open 2023;13:e064715. doi:10.1136/ bmjopen-2022-064715  Follow us on twitter: @thrombosiscan Check out our website: https://thrombosiscanada.caSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Send us a text Dr Vicky Mai presented multiple times at the ISTH 2023. Dr Le Gal talks to her about the research that she presented and the implications. The first study that she presented was a systematic review with metaanalysis on thrombolysis in intermediate high and high risk PE. The second one was an abstract on a sub analysis of the PREDICTORS study which looked at the risk of recurrent VTE in patient who presented with a suspicion of recurrent VTE on anticagulation. And there's two projects on COPD exacerbation and pulmonary embolism. Join us on Twitter:@thrombosiscan@VickyMai@grelegalVisit www.thrombosiscanada.ca for more information and resourcesSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada