Don't Just Read the Guidelines

In this episode, Rich and Pip discuss vaccine-induced immune thrombotic thrombocytopenia and heparin-induced thrombocytopenia. They critique a recent paper that has shown that VITT has been around before vaccines against Covid-19. Importantly, they discuss which patients should be tested for spontaneous VITT- and HIT-like syndromes, and discuss a recent case.

The paper is: Schönborn L. et al. Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure. Blood. 2023 Dec 28;142(26):2305-2314.

In this episode, Pip and Rich discuss the FRAIL-AF study: Joosten et al. Safety of Switching From a Vitamin K Antagonist to a Non–Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation. 2024;149:279–289.

This trial randomised the switching of elderly frail patients who were established on a vitamin K antagonist to either remain on this treatment or switch to a direct oral anticoagulant. They found increased rates of bleeding in the switch arm. However, there is a lot of detail that is not in the abstract! Pip and Rich take a deep dive into the manuscript, discuss their thoughts with Chief Investigator, Geert Jan Geersing on the trial, and put the findings into context with consultant haematologist David Sutton.

To read more about this trial check out Rich's blog on it: https://classicalcompass.substack.com/p/frail-af

Links

FRAIL-AF: https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.123.066485

In this, the first episode of a new podcast, "Don't Just Read the Abstract", Drs Pip Nicolson and Rich Buka take a deep dive into the PACER trial: Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. After a quick round up of other trials that have sparked their interest, Pip and Rich discuss about the study aims and outcomes, before interviewing Dr Floor van Baarle, lead study author before discussing the clinical implications of the trial with Prof Simon Stanworth.

Follow Pip, Rich, and HaemSTAR on X/Twitter: @PipNicolson, @RichardBuka, and @HaemSTAR_UK

To claim CPD credits, please email [email protected].

Links

- van Baarle et al. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. NEJM, 2023.

- Matsushita et al. Phase 3 Trial of Concizumab in Hemophilia with Inhibitors (explorer7). NEJM, 2023.

- Joosten et al. Safety of Switching from a Vitamin K Antagonist to a Non-Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients with Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation, 2023.

- Warkentin et al. Adenovirus-Associated Thrombocytopenia, - Thrombosis, and VITT-like Antibodies. NEJM, 2023

- Zhao et al. Intracerebral Hemorrhage Among Blood Donors and Their Transfusion Recipients. JAMA, 2023

HaemSTAR is an independent UK-wide network of registrars in clinical haematology, interested in promoting and performing research in classical haematology. Our focus is on collaborative projects across haemostasis & thrombosis, transfusion, general haematology, and obstetric haematology.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

Produced by Joe Apperley. All rights reserved.

This episode is a first for me. I speak to Angie, a patient who I first looked after in 2021 whilst she was receiving chemotherapy for AML. She went on to have a successful stem cell transplant and is ready to share her story.

There are so many unexpected lessons here and it's a must listen for anyone involved in caring from haemato-oncology patients. You also need to listen to this to find out why I compared her to a kiwi after she had had to shave her head.

WARNING: I do not recommend listening to this if you are a patient or a relative of someone who has recently been diagnosed with acute leukaemia.

In this episode, I talk to Sophie Evans. Sophie is an internal medicine trainee and budding haematologist in the southwest of England and has a real interest in the importance of stories in medicine. We met after she took part in the BSH Crucible Prize where she presented her ideas along with beautiful hand-drawn images on her slides. We discuss narrative-based medicine as well as graphic medicine. This is a really intriguing discussion that will change how you think about how you consult and I hope can change your practice for the better.

You can find Sophie's art on Instagram: www.instagram.com/sophietevans/. She mentions this book: https://www.amazon.co.uk/Narrative-Based-Medicine-Trisha-Greenhalgh/dp/0727912232, Ian Williams, who coined the phrase "Graphic Medicine" (https://myriadeditions.com/creator/ian-williams/) and I mentioned a really interesting study on Evolution and the Art of Storytelling: https://www.nature.com/articles/s41467-017-02036-8

I hope you enjoy the show.

In this episode, I chat to Jane Rutherford, a haematology speciality doctor in Inverness. As part of a team of 5 consultants, 2 advanced nurse practitioners, and herself, she covers both NHS Highland and NHS Western Isles, an area comprising over 15,000 square miles and a population of over 350,000 people. Life can be a real challenge - from dealing with snow drifts, tidal islands, and small boats, the team manage to provide first class haematology care to patients with acute leukaemias, ITP, haemophilia, and everything else in between. This is a wide ranging chat about the trials and tribulations as a rural haematologist. If you do want to get in touch with Jane about possibly going to work in Inverness, feel free to email her: [email protected]

Gordon Caldwell is a recently retired NHS medical consultant who has worked all over the UK. His passion is quality in healthcare and he has spearheaded efforts to improve efficiency in the NHS. He is an advocate for improving the use of IT to diminish the need for repetitive tasks and has started a campaign called #CutTheCrap. This has the aim of liberating healthcare staff from burdensome paperwork and freeing them up to spend more time with patients, delivering excellent care.

If you are an NHS manager and you are interested how you can improve your organisation, this would be a great place to start. Gordon can be found on Twitter: @DoctorCaldwell.

I quote a study in the episode - here's the link:

Webster et al. 2011. Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial). BMJ Quality & Safety

https://qualitysafety.bmj.com/content/20/4/297

Mark Thomas is an Associate Professor in Cardiology at the University of Birmingham and an Honorary Consultant Cardiologist at University Hospitals Birmingham. Mark is very interested in the pharmacology of coronary artery disease, data science, and artificial intelligence. Here we have a wide ranging discussion about antiplatelets drugs as well as artificial intelligence.

You can find out more about Mark here: https://www.birmingham.ac.uk/staff/profiles/cardiovascular-sciences/thomas-mark.aspx

“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.” Keith Hansen

Dr Wendy Jones MBE is a pharmacist with over 40 years’ experience supporting breastfeeding mothers. Who website www.breastfeeding-and-medication.co.uk is an awesome resource which includes an unbelievable amount of information for both clinicians, mothers, and families about drugs (yes – both prescribed and illicit!) and breastfeeding.

Why do I care about breastfeeding? Well, my wife Holly has breastfed both my little ones and now I really understand how important it can be for some mothers, but also how hard it can be when we are fighting against a society that does not value breastfeeding. Breastfeeding is so important to Holly that she joins me as a special guest on this episode!

This is an episode you won’t want to miss and I think you will find it really interesting whoever you are.

Here are some links to some fantastic resources:

Wendy’s website: www.breastfeeding-and-medication.co.uk

Wendy’s books: breastfeeding-and-medication.co.uk/books

Wendy’s top recommendation for clinicians: www.amazon.co.uk/Guide-Supporting-Breastfeeding-Medical-Profession/dp/0367206463

Another recommendation – a book from Amy Brown: www.amazon.co.uk/Breastfeeding-Trauma-Matter-Pinter-Matters/dp/1780666152

Eddie Cliff is an Australian haematology registrar with academic interests in health policy, lymphoid malignancies, and public health. He is currently at Harvard doing a fellowship with PORTAL (Program on Regulation, Therapeutics and Law), to help advocate for lower prices for drugs and make them more accessible.

In this podcast we talk about healthcare funding, health policy, clinical trials, polatuzumab, and the implications of VITT on the future of adenoviral vector vaccines.

Read more about Eddie here:

https://www.hsph.harvard.edu/news/features/bringing-heart-and-humanity-to-hematology/