So you’ve been asked to start a DOAC? How is that different from a NOAC? Is there a difference? Which one should you start? Is warfarin a WOAC? How do I initiate these drugs? Why is the dose weird at the beginning? Do I need to check my dose is appropriate? 

If oral anticoagulation has you discombobulated you are in the right place!! In part II on the practical management of anticoagulation we are here to clarify all your questions on the most common types of oral anticoagulation you will come across as a junior doctor on the wards.

Timestamps
1:44 - Part I Recap and Part II Introduction
3:44 - History of Warfarin
8:37 - Mechanism of Warfarin
13:01 - Monitoring Warfarin
16:52 - Why Warfarin? and warfarin tips
21:40 - Warfarin reversal
31:05 - Warfarin Skin Necrosis & Drug Interactions
36:08 - Warfarin in Special Circumstances
40:25 - DOACs Intro
41:12 - Dabigatran
48:25 - Anti-Xa Agents (Rivaroxaban / Apixaban)
52:38 - Anti-Xa Monitoring (or not)
59:28 - DOACS - Special Circumstances
1:05:58 - Wrapup

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Does my blood look fat in this?

Does the idea of heparin being a fraction make you wish you listened harder in maths? What is unfractionated heparin? Why are haematologists so judgmental and prefer their anticoagulation low molecular weight? Why does haematology frown when you use the term “blood thinners” ?!?!

If injectable or parenteral anticoagulation feels confusing you have come to the right place! Today we look at unfractionated heparin and low molecular weight heparin,  practical things to think about and how to manage these drugs safely on the wards and beyond 

NB We’re going to leave the advanced injectables like Fonda/Danaparoid/Bivalirudin to a dedicated alternative, probably HITTS themed episode if you’re looking for these drugs

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Twas the night before Christmas, and all through the house, not a creature was stirring, particularly not a missing coagulation factor. Welcome to a very special present all wrapped and delivered by Santa and his Christmas elves and stuffed in your podcast queue in time to drive off for the holidays. Join Cale, a very dusty Bashar, Nick and Santa as we learn a little bit about Christmas Disease. We swear his jacket was that colour before we messed with his haemostatic pathways… CONTENT WARNING: Singing

TIMESTAMPS

00:55 - Pure unbridled musical talent 
03:34 - Intro to Christmas Disease/Haemophilia B
04:58 - History of Haemophilia B
14:01 - Presentation of Haemophilia B
18:25 - Haemophilia B Leyden
22:49 - Coagulation studies in Haemophilia B
26:20 - Treating Haemophilia B
28:12 - Where does factor replacement come from?
31:57 - Inhibitors
33:48 - Gene therapy
37:27 - Take home messages

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We’ve had one difficult coagulation topic yes, but what about second difficult coagulation topic? We are joined by the fantastic Dr Caroline Dix today to take us through not one but TWO challenging scenarios in thrombosis. First we’ll be revisiting Cerebral Venous Sinus Thrombosis but this time with someone who knows what they are doing. After that we’ll cover anticoagulating people when some very fundamental parts of the system are broken - the management of antithrombin deficiency. This episode wraps up our journey through clots… for now. 

Timestamps:

2:08 - Introducing Dr Caroline Dix
8:03 - CVST - Risks
11:15 - CVST - Clinical
18:08 - CVST - Duration
21:05 - Antithrombin Deficiency
25:12 - Antithrombin Deficiency - Diagnosis
29:43 - Antithrombin Deficiency - Management
37:34 - Wrapup

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Sometimes something comes along that puts a chill down the spine of every doctor. Any conversation that starts with "Oh hey do you remember that patient you saw...?". Mystery meat day in the cafeteria. Dealing with hospital executives. For these times in life you need a guide. Today we'll be covering one of those spine-chilling clinical scenarios with our very apt guide consultant haematologist Dr Sara Ng. Over forty minutes Sara will un-chill your spine with her practical approach to managing thrombosis when there just aren't that many platelets to go around, as well as talking about conditions where clots and thrombocytopenia are intimately linked.

Timestamps: 

2:11 - Introducing Dr Sara Ng
7:18 - Case 1: Acute PE and Thrombocytopenia
14:55 - Case 1.5: Subacute PE and Thrombocytopenia
18:20 - Case 2: Line Thrombus during Chemotherapy
22:09 - Thrombosis in ITP
26:15 - Oh no a STEMI
27:44 - Two sides of the same coin
31:58 - How 2 4T Score - HITS
35:15 - Other PF4 Antibodies
38:33 - Wrap up & Takehomes

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Come one come all to see the thinnest extended reference in the universe. Draped over not one but TWO episodes, the Bloody Minded Crew continue to make vaguely topical references to popular recent films. Look - we go outside and experience the full gamut of popular culture. Oh and we finish up our discussion of thrombophilia testing in the lab - looking this week at activated protein C resistance testing, molecular Factor V Leiden assessment and Prothrombin gene mutations.

TIMESTAMPS

1:06 - Pay no attention to the man behind the curtain
3:10 - Activated Protein C resistance testing
10:27 - Testing in Australia for APCR
17:17 - FvL Testing
18:51 - PCR - Polymerase Chain Reactions
22:52 - Melt curve analysis
27:39 - Prothrombin G20210A Testing
28:44 - Take Home Messages

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Lions and tigers and… thrombosis? Oh my! Join the Bloody Minded Crew on the yellow brick road to visit the emerald laboratory and see the wonderful wizard of clots - your friendly laboratory coagulation scientist! Put on your blood red ruby slippers and join us for this bumper lab episode as we learn about how exactly we test for Protein C, S and antithrombin deficiencies as well as lupus anticoagulants. By the end of it you’ll have a brain for coags, a heart full of of love for thrombosis and the courage to peer behind the laboratory curtain 

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“HATE. LET ME TELL YOU HOW MUCH I'VE COME TO HATE YOU SINCE I BEGAN AS A HAEM REG. IF THE WORD HATE WAS ENGRAVED ON EACH NANO-ANGSTROM OF THE HUNDREDS OF MILLIONS OF CONSULT NOTES I HAVE WRITTEN IT WOULD NOT EQUAL ONE BILLIONTH OF THE HATE I FEEL FOR YOU ORDERING THROMBOPHILIA TESTING INAPPROPRIATELY.” Woah - Let’s calm down, that's a bit much. Cale and Bashar are exposed to Nick’s inner monologue as the Bloody Minded Crew learn about the what, when and when not of thrombophilia testing. 

TIMESTAMPS

0:52 - Nick gets stuck in an anger loop  
2:19 - Intro to thrombophilia testing  
4:25 - Inherited thrombophilias  
5:38 - Surprise historical diversion on antithrombin  
8:14 - Proteins C and S  
9:31 - Factor V Leiden  
10:56 - Prothrombin gene mutation  
11:52 - Risk profiles in inherited thrombophilia  
18:49 - Acquired thrombophilias  
18:56 - Antiphospholipid syndrome  
19:46 - PNH  
20:22 - JAK2  
21:08 - Mid-ep summary  
22:28 - The world's biggest soapbox: what not to do  
23:25 - Soapbox: no MTHFR pls  
25:19 - Soapbox: bad times to test  
26:46 - Soapbox: don't test the obvious provoked clots  
27:30 - Bonus soapbox: factor V levels vs Leiden  
28:54 - When SHOULD we test?  
30:41 - Benefits of testing  
32:33 - Clinical scenario: spoiler, no real answer  
33:26 - Scenarios where you might test  
37:49 - Take home messages  

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We're nearly out of pipes to clean - Join us for the world's worst roadtrip we venture into the lesser known parts of human plumbing and tackle unusual site thromboembolism. From splanchnic clots, uterine and testicular thrombi it's clots as far as the eye can see (and those it can't like CRVO!)

Timestamps:

0:58 - ROADTRIP
4:07 - CVST
11:07 - CVST - Treatment
15:36 - Lemierre's
17:50 - CRVO
24:36 - Splanchnic Thrombi
34:45 - Renal Vein Thrombi
39:41 - Uterine Vein Thrombus
42:09 - Ovarian Vein
44:42 - Testicular Vein
46:35 - Takehomes

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It's said that beauty is skin deep but you know what else lurks just under your epithelium - CLOTS! Nick, Cale and Bashar head very slightly under our outer layer to the peripheral vasculature in this increasing tortured metaphor as we learn on our shortest episode to date about what to do when those not so deep vessels fill with thrombus. 

Timestamps

2:12 - Where are superficial veins?
5:23 - What's the deal with thrombophlebitis
7:34 - MONDOOORS (To the tune of Trogdor)
9:11 - Risk Factors for SVT
10:56 - Investigations
11:53 - Treatment
17:54 - Summaries

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Check out show notes, additional references and (sometimes) extra content at www.bloodyminded.com.au