Post-thrombotic Syndrome and the TILE Study

This 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.

AND

Julia 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’ series

https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1234

Spot the CLOT’: What cancer patients want to know https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1262

Spot the CLOT’: Awareness of cancer-associated thrombosis in healthcare providers

https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1277/1067

Spot the CLOT: Treatment considerations for CAT

https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1372

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Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In 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 

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The 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)

And

Dr 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  

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https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

 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. 

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@VickyMai
@grelegal

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https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Dr Abdulrehman interviews three researchers working in Canada who presented work at ISTH 2023 in Montreal. Dr Menal Huroy, reviews her poster on The Impact of GI Surgeries on peak plasma anti-Xa Direct Oral Anticoagulant levels, Dr Adam Suleman discusses his research on The Risk iof VTE in Primary CNS Lymphoma: A Systematic Review and Dr Ismail Raslan discussed his research, Anticoagulation Post-Pulmonary Endarterectomy: A Retrospective Cohort Study. Three quick interviews covered in 11 minutes!

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Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

Join us for an in-depth conversation with Dr Lucia Caiano and Dr Tzu-Fei Wang, two of the authors of a review exploring the potential role of statins in preventing post-thrombotic syndrome (PTS), a frequent long-term complication of deep vein thrombosis (DVT). They dive into their systematic review and meta-analysis, discussing the intriguing findings drawn from 1971 screened records. The interview reveals their insightful interpretations of data, including the possible 22% reduction of PTS incidence with statin use. Yet, they also acknowledge the limitations seen in randomized controlled trials (RCTs). The conversation offers an invaluable opportunity to better understand the challenges of PTS prevention, the promising role of statins, and the crucial need for larger RCTs to confirm these findings. Don't miss this chance to gain expert insights into this rapidly developing field of medical research.

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@ThrombosisCan
@TzufeiWang

Ref:

Caiano L, Drury T, Zahrai A, Wang TF, Siegal DM, Rodger MA, Fournier K, Delluc A. Role of statins in the prevention of post-thrombotic syndrome after a deep venous thrombosis event: a systematic review and meta-analysis. Journal of Thrombosis and Haemostasis. 2022 Dec 22.

https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In this episode of CLOT Conversations we interview Dr Saskia Middeldorp and Dr Hanke Wiegers, authors of the groundbreaking Highlow study. This open-label, multicenter, randomized controlled trial aimed to determine the optimal dose of low-molecular-weight heparin (LMWH) for pregnant and postpartum women with a history of venous thromboembolism (VTE). Discover the study's findings on the incidence of recurrent VTE, major bleeding, and death from any cause between the intermediate-dose (ID) and low-dose (LD) LMWH groups. The results may surprise you and highlight the need for individualized dosing strategies for pregnant and postpartum women to balance the risks and benefits of anticoagulant therapy. Don't miss this fascinating episode!

Dr Saskia Middeldorp is Professor of Medicine and Head of the Department of Internal Medicine of the Radboud University Medical Center in Nijmegen, The Netherlands. Prior to her transfer to Nijmegen in January 2021, she has been a professor of Medicine at Amsterdam University Medical Centers for over 10 years, leading the clinical thrombosis and haemostasis research lines of the Department of Vascular Medicine. Since January 2023, Saskia Middeldorp is one of the 4 Research Domain Leaders in the Radboudumc Research Institution for Medical Innovation.

Her present research focuses on several aspects of hereditary and acquired thrombophilia, women’s issues in thrombosis and haemostasis, and the clinical evaluation of new anticoagulants and antidotes.

Dr Hanke Wiegers is an MD, PhD student, at the department of vascular medicine at the Amsterdam UMC, location AMC. In June 2019 she started her PhD trajectory under the supervision of Prof. Dr. S. Middeldorp as supervisor and focuses particularly on women & thrombosis. On the 17th of March 2023 she will defend her PhD thesis entitled: “Progress in prevention and prediction of venous thromboembolism in women – focus on pregnancy and the postpartum period.”  Hanke Wiegers started as a gynecologist in training on the 1st of January 2023 

Bistervels, I. M., Buchmüller, A., Wiegers, H. M., Áinle, F. N., Tardy, B., Donnelly, J., ... & Zelis, M. (2022). Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial. The Lancet, 400(10365), 1777-1787 

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@MiddeldorpS

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Don't miss our latest podcast interview with Dr Joseph Shaw and Dr Tzu-Fei Wang who discuss insights from their single-center retrospective cohort study, which included 264 patients with nonvalvular AF and Cancer undergoing 302 periprocedural interruptions. Learn about the primary endpoints, which were the 30-day risks of arterial thromboembolism and major bleeding, and the results that showed relatively low risk for these complications when patients were managed according to commonly applied perioperative management recommendations. Tune in now to gain valuable knowledge on this important topic.

Aziz, Joseph, et al. "Thrombotic and Bleeding Outcomes Following the Perioperative Interruption of Anticoagulation Among Patients with Non-Valvular Atrial Fibrillation and Active Cancer." Journal of Thrombosis and Haemostasis (2022).

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Dr Wang: @TzufeiWang
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Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In this interview, two of the authors of the paper Direct oral anticoagulants vs vitamin-K antagonists in thrombotic antiphospholipid syndrome: meta-analysis of randomized controlled trials, Dr Jean Connors and Dr Benhood Bikdeli, provide listeners with an overview of their systematic review and meta-analysis that evaluated the efficacy and safety of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) in patients with thrombotic antiphospholipid syndrome. The authors searched through three databases (PubMed, EMBASE, and Cochrane Central Register of Controlled Trials) and found four eligible randomized controlled trials with a total of 472 patients. Our podcast guests discuss the results of the study and the clinical implications.  

About our guests:

Dr Jean M Connors: 
Jean M. Connors, MD is a hematology attending at Brigham and Women’s Hospital and Dana-Farber Cancer Institute; the Medical Director of the Anticoagulation Management Services, and the Hemostatic Antithrombotic Stewardship Program; and an Associate Professor of Medicine at Harvard Medical School.

 She received a medical degree from The Johns Hopkins University in Baltimore, completed her residency in internal medicine at Beth Israel Deaconess Medical Center in Boson, as well as fellowships in transfusion medicine and hematology & oncology from Brigham and Women’s Hospital.

Dr. Connors is an Associate Editor for the Journal of Thrombosis and Haemostasis and the Journal of the American College of Cardiology: Basic to Translational Science. She is a member of or holds a leadership role in many professional societies, including ASH and ISTH. She has participated in numerous clinical trials for patients with venous thrombosis in cancer, and anticoagulation questions in general.

Dr Benhood Bikdeli:
Behnood Bikdeli, MD, MS is a clinician-investigator, with training in cardiology and in vascular medicine who is particularly interested in thrombotic diseases. He is an Associate Physician in the Division of Cardiovascular Medicine at Brigham and Women’s Hospital, an Instructor in Medicine at Harvard Medical School, and an investigator at Yale Center for Outcomes Research and Evaluation (CORE). His research has been funded by the NIH, the American Heart Association, Brigham and Women’s Hospital and others.

Dr Bikdeli has coauthored over 180 publications, which have been published in journals including Lancet, JAMA, JAMA Internal Medicine, Circulation, Journal of the American College of Cardiology, the British Medical Journal, and others. Dr. Bikdeli was the lead author of two international consensus documents related to thrombosis in COVID-19, is the joint principal investigator of the INSPIRATION/ INSPIRATION-S randomized controlled trial, and is an Associate Editor for Thrombosis Research.

Ref:
Khairani, C. D., Bejjani, A., Piazza, G., Jimenez, D., Monreal, M., Chatterjee, S., ... & Bikdeli, B. (2022). Direct oral anticoagulants vs vitamin-K antagonists in thrombotic antiphospholipid syndrome: meta-analysis of randomized controlled trials. Journal of the American College of Cardiology.

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@connors_md

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Are you curious about how to improve the safety and effectiveness of anticoagulant prescriptions for hospitalized patients? Join us for an exclusive interview with two of the authors (Dr Maral Koolian and Pharmacist Ryan Kerzner ) of a groundbreaking study on anticoagulation stewardship program at the Montreal Jewish General Hospital. Our guests will share their findings on the success rate of recommendations made by a multidisciplinary team of physicians and pharmacists, as well as the most common types of adjustments made to prescriptions. Don't miss this opportunity to learn more about the potential benefits of these programs and the future research needed to fully understand their impact on patient outcomes. Download this episode today!

Koolian, M., Wiseman, D., Mantzanis, H., Kampouris, N., Kerzner, R. S., & Kahn, S. R. (2022). Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription. Research and Practice in Thrombosis and Haemostasis, 6(6), e12758. 

Guest Biographies: 

Dr Maral Koolian is an Assistant Professor of Medicine and the Director of the Adult Thrombosis Medicine AFC program at McGill University. She is a member of the Division of General Internal Medicine and the Centre of Excellence in Thrombosis and Anticoagulation Care (CETAC) at the Jewish General Hospital. She earned her medical degree at McGill University, where she subsequently completed post-graduate subspecialty training in General Internal Medicine. She then completed a 1-year clinical thrombosis fellowship at the University of Ottawa, followed by an MSc in Quality Improvement and Patient Safety at the University of Toronto. Her main research focus is quality improvement principles as they apply to venous thromboembolic disease and anticoagulation management. 

Ryan Kerzner graduated with a Bachelor of Pharmacy and a Masters in hospital pharmacy from the Université de Montréal. He has been a pharmacist at the Jewish General Hospital in Montreal since 2008. He is one of the co-founders of the hospital's Antimicrobial Stewardship programs, in which he is still actively involved. He also works in Internal Medicine where he developed an interest in Thrombosis medicine. He officially joined the hospital's CETAC team in 2019, which is the Centre of Excellence in Thrombosis & Anticoagulation Care. In CETAC, with Dr Koolian and 2 other thrombosis pharmacists, he was involved in the development an Anticoagulation Stewardship Program. 

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@MKoolian
@Pharmacist_MTL

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https://thrombosiscanada.ca

Take a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada