Thrombosis in conversation

Episode 29: Individualised care in special populations

“We must be patient centred.” Dr Steven Deitelzweig and Dr Barnes address the challenge of balancing bleed risk and thrombosis prevention in special populations, such as those with obesity, frailty, or chronic kidney disease. With up to 50% of patients not resuming anticoagulation following a bleed, they emphasise the importance of shared decision-making to guide treatment in patients for whom the evidence is uncertain.

Episode 28: Real-world evidence: Addressing gaps in VTE and AF clinical research

What makes good real-world evidence (RWE), and why does it matter? Dr Steven Deitelzweig joins Dr Barnes to discuss how physicians can assess the quality of RWE and its potential to expand our understanding of the safety and effectiveness of treatments beyond clinical trial data, helping to guide anticoagulation in understudied populations.

Episode 27: A multidisciplinary approach to CAT

“As soon as you have a cancer diagnosis, the odds [of VTE] increase 4-fold, 6.5-fold if that particular patient is initiating chemotherapy.” Dr Marc Carrier and Dr Geoffrey Barnes use a case study to talk through the decision-making process and specific needs for anticoagulation in patients with cancer. They highlight the need for a multidisciplinary approach, how tools such as the Khorana score inform treatment, and the patient group that rarely receives thromboprophylaxis despite having a number needed to treat of just 25 to prevent one clot.

Episode 26: From pragmatic trials to everyday treatment – DOACs for CAT

Around 50% of patients eligible for anticoagulation treatment do not meet the usual inclusion criteria for randomised controlled trials (RCTs). Dr Marc Carrier joins Dr Barnes for a discussion of three recent RCTs with a pragmatic approach – CANVAS, RENOVE, and ONCO PE – and how these have addressed important questions about the clinical approach to CAT, including how long to continue direct oral anticoagulation (DOAC) treatment and whether to reduce the dose.

Episode 25: AF and CKD – A “tight association”

“We have to be careful about who we label with chronic kidney disease.” Dr Piazza returns to talk to Dr Barnes about renal dysfunction in the context of AF, including the factors to consider to ensure a clinically relevant diagnosis, why intentional underdosing of anticoagulants may do more harm than good, and the use of warfarin versus direct oral anticoagulants in patients with end-stage renal disease.

Episode 24: Clinical considerations: Managing treatment switches

Clinical pharmacist Dr Arthur Allen joins Dr Barnes to discuss how to navigate transitions between anticoagulants, including when and why to use bridging low-molecular-weight heparin, the patient characteristics that may influence management, and why switching guidance in the prescribing information is not practical. Also, amid local variations in care models and cultures, what is the key factor that can determine the success of physician–pharmacist collaborative care?

Episode 23: From hospital to community: Transitions in VTE care

Dr Piazza and Dr Barnes discuss how collaboration and a clear message can ease the transition from hospital to home, and the return to daily routines, for people recovering from VTE. Our experts discuss the optimal timing of thrombophilia testing, supporting medication adherence and getting patients moving again.

Episode 22: Selecting anticoagulants: Individualised approaches

“We can definitely utilise each other’s strengths and expertise and make some synergy. We all have the same goal here.” Clinical pharmacist Dr Sara Vazquez and Dr Barnes discuss how physicians and pharmacists can collaborate to create more effective, individualised treatment approaches, and outline strategies to ensure patients are meaningfully involved in decisions about their treatment.

Episode 21: Optimising adherence in anticoagulation therapy

Dr Barnes and Dr Sara Vazquez consider the diverse factors that influence patients’ adherence to anticoagulant therapy, including “nuisance bleeding”, pill burden, and whether treatment is to prevent AF or VTE. They also look at different ways to build habits that can work for different individuals, and Dr Vazquez offers practical tips for effective communication with patients about their medications.

Episode 20: “If you measure it, you can improve it” – AI for managing AF

Artificial intelligence (AI) in cardiovascular care is empowering researchers and clinicians to uncover new findings that were previously undetectable. These data enable more sophisticated conclusions for guiding clinical decision-making. Dr Rohan Khera joins Dr Barnes to examine the present and future impact of AI technologies on the management of AF.