CLOT Conversations Thrombosis Canada

This 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.
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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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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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 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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Support the show
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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Support the show
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