Welcome to the North American Thrombosis Forum
February 2012: NATF President’s Letter
2012 got off to a good start as the Staff and Board Members of NATF brainstormed on how to maximize participation among our several thousand members. Over the next 6 months, you will see our website evolve into a more user-friendly and easier-to-navigate destination. We will reach out to younger members through social media and live events, beginning in the Boston area.
As we focus on pulmonary embolism (PE) and deep vein thrombosis (DVT) this calendar year, our goal is to join clinicians and advocacy groups toward an ambitious goal: near eradication of PE and DVT that begins during hospitalization in the absence of preventive measures. And some of us will work on strategies to prevent PE and DVT from striking after discharge from the hospital. We have the necessary pharmacological tools to block most PE and DVT, but defining appropriate high risk groups in whom to target prevention measures after hospital discharge remains a work in progress.
And we have a mission to reduce strokes as well, particularly those preventable strokes in patients with underlying atrial fibrillation. As new drugs which offer advantages over warfarin receive FDA approval, we will expand the pool of individuals eligible for anticoagulants, with fewer bleeding complications and more convenience in dosing than ever before.
Samuel Z. Goldhaber, MD
President, NATF
Latest NATF Corner Article:
Obesity and pulmonary embolism:
The mounting evidence of risk and the mortality paradox
Authored By: Paul D. Stein a,b,⁎, Fadi Matta a,b, Jose Goldman c
a Department of Research, St. Mary Mercy Hospital, Livonia, Michigan
b Department of Internal Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
c Department of Internal Medicine, Michigan State University, East Lansing, Michigan
a b s t r a c t
Purpose: To determine the prevalence of pulmonary embolism in obese patients according to age, gender and comorbid conditions and explore the relation of obesity to mortality. Methods: The number of patients discharged from short-stay hospitals throughout the United States from 1998–2008 with pulmonary embolism who were obese or not obese, and in-hospital all-cause mortality were determined from the Nationwide Inpatient Sample.
Results: From 1998–2008, 203,500 of 17,979,200 (1.1%) obese patients were diagnosed with pulmonary embolism compared with 2,034,100 of 346,049,800 (0.6%) non-obese patients [relative risk (RR) =2.03]. Relative risk for pulmonary embolism was highest among obese patients aged 11–20 years (RR=5.80) and was higher in obese women (RR=2.08) than in obese men (RR=1.74). Mortality was 4.3% in obese patients with pulmonary embolism compared with 9.5% in non-obese patients (RR=0.45). Obesity had…
New Stroke-Prevention Drugs Spur A-Fib Guides
Family Practice News:
Dr. Samuel Z. Goldhaber on Stroke Prevention in Atrial Fibrillation
The effort, spearheaded by the ACP Foundation’s Initiative on Atrial Fibrillation and Stroke Prevention, shores up the role of primary care in atrial fibrillation management at a time when newly approved alternatives to warfarin have dramatically expanded treatment options. “You don’t need to be a specialist to prevent a stroke from atrial fibrillation,” said Dr. Goldhaber, a member the initiative’s panel.
Announcement:
NATF’s DVT/PE Risk Assessment Tool won the Silver Award from the Web Health Awards!
The goal of the Web Health Awards is to recognize high-quality digital health resources for consumers and health professionals. The National Health Information Awards program is organized by the Health Information Resource Center (HIRC), an 18 year old national clearinghouse for professionals who work in consumer health fields.
Announcement:
A new series of AHA and TCT programs on cardiovascular medicine and thrombosis are available on our Online Programs page. Take the opportunity to register.
April 12, 2012:
Exhibitors are now being considered for the Atrial Fibrillation Management in 2012 – A New State-of-the-Art
Click here for more information.
“Bridging” anticoagulation may not be necessary in vast majority of patients
American Heart Association:
To bridge or not to bridge? Pros and cons of this approach
November 13, 2011 – by Lisa Nainggolan
theHeart.org coverage of Dr. Goldhaber’s talk on bridging at
the American Heart Association 2011 Scientific Session in Orlando, FL was the most read article on theheart.org.
Speaking to a packed room at the American Heart Association 2011 Scientific Sessions this morning, with his talk being broadcast outside to those who could not get in, Dr Samuel Z Goldhaber (Brigham and Women’s Hospital, Boston, MA) did a quick poll of his audience and discovered that 90% had “bridged” patients. “But there is a lack of evidence. There are no randomized clinical trials to say that bridging is the way to go,” he observed.
Click here to read the entire article.
NATF President and Founder, Dr. Samuel Goldhaber (Brigham and Women’s Hospital, Boston, MA) and Dr. Manesh Patel (Duke Clinical Research Institute, Durham, NC) discuss results of the Apixaban Dosing to Optimize Protection from Thrombosis (ADOPT) Trial on extended anticoagulant prophylaxis in initially hospitalized medically ill patients - Filmed at AHA 2011. The abstract, news release, audio, and presentation and discussant slides for Dr. Goldhaber’s full lecture on the ADOPT Trial are available here.
Nationalizing PE Patient Support Groups
Dr. Caprini and his assistant, Nancy Lala, hosted their first PE Support Group last week at NorthShore University HealthSystem in Illinois. The Support Group was a success with nearly 20 attendees. The next Support Group in Illinois is not yet scheduled, but is expected to be in January. If you are in the area, or interested in joining the Support Group, please contact Nancy Lala at NLala@northshore.org with any questions.
Here at NATF, Ruth Morrison and Kathryn Mikkelsen are continuing their efforts in nationalizing PE Patient Support Groups. For questions regarding hosting a PE Support Group in your area, please email Kathryn Mikkelsen at kzmikkelsen@partners.org.
2011 NATF Summit Keynote Speaker – Dr. Bulat shares his story:
Thrombolysis in PE: A Physician-Patient Perspective
Latest News:
NATF Member Starts Support Group
Click here to read a recent article featuring NATF Advocacy Committee member Brenda Blackburn and her efforts to form patient support groups for survivors of deep vein thrombosis (DVT) and pulmonary embolism (PE).
Samuel Z. Goldhaber, MD, and Christopher Kabhrel, MD, publish new paper
Our director, Samuel Z. Goldhaber, MD, has coauthored a new paper in BMJ Magazine concerning sedantary lifestyles and its relation to pulmonary embolism. Co-author Christopher Kabhrel MD has been interviewed by our staff, and here are his thoughts:
Click here to watch on youtube.
NATF Spotlight: Apixaban vs. Warfarin
Dr. Piazza discusses recently released outcomes of the drug trial entitled “Apixaban for the Prevention of Stroke in Subjects with Atrial Fibrillation” (ARISTOTLE).
For additional information on this trial, click here.
NATF Fellow Launches Website
2009 NATF Traveling Fellow, Sara Vazquez, PharmD, BCPS, CACP has successfully completed her Fellowship project! A website dedicated to post-thrombotic syndrome (PTS) awareness and education is live!
Highlights for healthcare providers include:
· 60-minute webcast with overview of PTS
· Three 20-minute online modules (PTS Risk Factors, PTS Prevention, and PTS Diagnosis and Treatment)
· Total of 2 hours of free CE/CME credit available with completion of webcast and all online modules
· Downloadable tools:
o Worksheet for assessing PTS risk factors
o Step-by-step instructions for how to prescribe compression stockings
o Villalta scale PTS diagnosis worksheet
o Compression stocking handout for patients
· Videos:
o Susan Kahn, MD conducting patient interview and demonstrating PTS assessment
o Demo of proper leg elevation technique
Patients can find helpful resources, tools, and videos as well!
Deep Vein Thrombosis: I Thought It Was Just a Sprained Ankle
Source: http://www.health.com/health/article/0,,20489056,00.html
Injuring your ankle shouldn’t be a big deal, right? I was 35 and otherwise in perfect health. But three weeks after I sprained and broke mine by tripping on a stair, I was being rushed to a hospital, weak, gasping for air, literally minutes from death.
What happened? It turned out that a large blood clot—a serious condition known as deep vein thrombosis (DVT)—formed in my leg as I tried to recuperate. The clot broke off and traveled to my lungs (what’s known as a pulmonary embolism), where it blocked blood flow—and threatened my life. You may recall that in 2003 NBC correspondent David Bloom died from a pulmonary embolism after being dehydrated and sleeping curled up in a tank for weeks while reporting in Iraq. And recently, tennis champion Serena Williams made headlines when she was hospitalized and treated for a pulmonary embolism and related complications (see “Behind Serena’s Scare,” below).
To read the entire article, Click Here
Actress and Plus-Size Model Mia Amber Rose dies from unknown causes, speculated to be from a blood clot
May 12, 2011
To read the entire article, Click Here
Tall, obese men at higher risk for blood clots
April 29, 2011 – By Marrisa Cevallos, HealthKey
Tall and obese men appear more likely to develop venous thromboemoblism, which can lead to a potentially lethal blood clot in the lungs, according to a study published Thursday.
To read the entire article, Click Here
Interview with Gregory Piazza, MD
Discusses Pulmonary Embolism and the recent report that U.S. Women’s Tennis Player, Serena Williams, has been diagnosed with Pulmonary Embolism (PE)
Serena Williams Treated for Blood Clot in Lung, People Reports
By Eben Novy-Williams and Elizabeth Lopatto
March 2 (Bloomberg) – Serena Williams was treated for a blood clot in her lung, the latest setback after injuries that have kept the 13-time Grand Slam singles winner off the court since last July, People magazine said.
Williams, 29, was treated at Cedars-Sinai Medical Center in Los Angeles for the clot found last week, the magazine quoted the player’s representative Nicole Chabot as saying. The former No. 1-ranked player on the WTA women’s tennis tour also received emergency care two days ago for a bruise sustained as a result of “treatment for a more critical situation,” Chabot told the magazine. Williams, who hasn’t played a competitive match in more than seven months, may miss up to six months as she recovers from the condition, according to Jonathan Orens, associate director and clinical chief of pulmonary care at Johns Hopkins University School of Medicine. Chabot and Jill Smoller, who also represents Williams, didn’t immediately return voicemail messages seeking comment.
Williams last played in July, when she won her fourth Wimbledon title. She cut her foot on a shard of glass in Germany following the victory and had surgery that month. Williams had a second operation in October after re-tearing a tendon in her right foot. Raed Dweik, director of the pulmonary vascular program in the department of pulmonology and critical care medicine at Cleveland Clinic, said Williams’s clot could be a result of the foot injury.
Atrial Fibrillation Management in 2012 (Thursday, April 12, 2012)
Program Chair Samuel Z. Goldhaber, MD, of Harvard Medical School, is joined by a Elaine Hylek, MD, of the Boston University Medical Center and Jeffrey Weitz, MD, of McMaster University, in an overview of late-breaking advances in risk stratification and management strategies for stroke prevention in atrial fibrillation (SPAF). Click here to watch the webcast.
Obesity and pulmonary embolism: The mounting evidence of risk and the
mortality paradox
Authored By: Paul D. Stein a,b,⁎, Fadi Matta a,b, Jose Goldman c
a Department of Research, St. Mary Mercy Hospital, Livonia, Michigan
b Department of Internal Medicine, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
c Department of Internal Medicine, Michigan State University, East Lansing, Michigan
a b s t r a c t
Purpose: To determine the prevalence of pulmonary embolism in obese patients according to age, gender and comorbid conditions and explore the relation of obesity to mortality.
Methods: The number of patients discharged from short-stay hospitals throughout the United States from 1998–2008 with pulmonary embolism who were obese or not obese, and in-hospital all-cause mortality were determined from the Nationwide Inpatient Sample.
Results: From 1998–2008, 203,500 of 17,979,200 (1.1%) obese patients were diagnosed with pulmonary embolism compared with 2,034,100 of 346,049,800 (0.6%) non-obese patients [relative risk (RR) =2.03]. Relative risk for pulmonary embolism was highest among obese patients aged 11–20 years (RR=5.80) and was higher in obese women (RR=2.08) than in obese men (RR=1.74). Mortality was 4.3% in obese patients with pulmonary embolism compared with 9.5% in non-obese patients (RR=0.45). Obesity had…
New antithrombotics: The impact on global health care
Authored By: Charles E. Mahan a,⁎, John Fanikos b,
a University of New Mexico Health Sciences Center, Albuquerque, New Mexico
b Brigham and Women’s Hospital, Boston, Massachusetts
a b s t r a c t
New and generic forms of widely used medications introduced in the antiplatelet, anticoagulant and fibrinolytic therapeutic classes will have a world-wide impact on prescribing, practice guidelines, and routine patient care. However, several uncertainties regarding these agents will remain even after the publication of their respective pivotal trials or regulatory approval. These questions include dosing in the frail, the elderly, and in those with renal and/or hepatic dysfunction, timing of administration in the peri-operative period, efficacy and safety in subgroup populations such as patients with cancer, the interchangeability of biosimilar products, and outcome differences between new agents in the absence of head-to-head clinical trials. Additionally, new generic forms of widely used agents have recently impacted the United States (US) and Canadian market place and more are under development. Clinicians should be vigilant concerning these agents and be prepared to inform patients and make decisions with their use…
Combination warfarin-ASA therapy: Which patients should receive it, which patients should not, and why?
Authored By: James D. Douketis,
Department of Medicine, McMaster University and St Joseph’s Healthcare, Hamilton, ON, Canada
a b s t r a c t
Warfarin and acetylsalicylic acid (ASA) are widely used for the primary and secondary prevention of thromboembolic and atherothrombotic diseases in patients with chronic atrial fibrillation, coronary artery disease, valvular heart disease and venous thromboembolism. Combining these two agents is appealing because of potentially complementary antiplatelet and anticoagulant actions, which may be especially relevant for patients who have concomitant cardiovascular diseases, such as atrial fibrillation and coronary artery disease (CAD). Despite the potential therapeutic advantages of combination warfarin-ASA therapy, when multiple drugs that affect hemostasis are co-administered, this typically increases patients’ risk for serious bleeding…
NATF Shares News, Articles, Studies and Updates:
Announcement:
A new series of AHA and TCT programs on cardiovascular medicine and thrombosis are available on our Online Programs page. Take the opportunity to register.
Meet Behnood Bikdeli, MD : Key Web Content Contributor
Behnood Bikdeli, MD is a physician originally from Tehran, Iran and a Post-doctoral Associate in Cardiovascular Medicine at Yale University School of Medicine and at Yale/ YNHH Center for Outcomes Research and Evaluation (CORE). He has had a longstanding passion for cardiovascular medicine, a fact that is reflected in his consistent publications in the field, and scientific presentations in several countries and continents.
His major research interests include venous and arterial thromboembolism, atherogenesis, and heart failure. He has collaborated with NATF since 2007 and intends to continue his studies in internal medicine and cardiology and to pursue a career in research and clinical cardiology.
Contributed New Studies:
Intermittent Calf Compression Device for Prevention of DVT in at-risk Neurosurgical Patients.
Sobieraj-Teague et al. tested the usefulness of an intermittent calf compression device among 150 patients undergoing neurosurgical procedures in an open-label randomized controlled trial. All patients received graduated compression stockings and physiotherapy. There were three VTE events in the intermittent calf compression group, compared to 14 in the control group, a difference which was statistically significant.
Cerebral and Coronary Air Embolism Following CT-Guided Biopsy of a Pulmonary Nodule.
A case of fatal massive cerebral and coronary air embolism was lately reported in Circulation. A 58-year-old male with history of cirrhosis, hepatocellular carcinoma, and liver and kidney transplantation suffered from massive air embolism to the brain, heart, aorta, and coronary arteries after undergoing CT-guided fine needle aspiration biopsy of a pulmonary nodule. The patient succumbed to severe anoxic brain injury and cardiopulmonary arrest.
No Added Benefit from Enoxaparin Prophylaxis in Medical Patients Receiving Compression Stockings.
Findings of a large randomized controlled trial by Kakkar et al. did not show a difference in all-cause mortality or a composite of sudden death and pulmonary embolism in hospitalized acutely ill medical patients who received enoxaparin sodium (40mg daily) versus placebo for 10±4 days. All the enrolled patients had received knee-length compression stocking as mechanical thromboprophylaxis.
Risk of Acute Myocardial Infarction after the Death of Loved Ones.
Loss of loved ones would pose the patients at risk of myocardial infarction, according to a study by Mostowsky et al. The risk is greater within the first 24 hours of learning of the death and among patients with greater baseline coronary risk. The authors attribute their findings to the sympathetic activation due to emotional stress and subsequent increase in vascular resistance as well as possible ruptures in vulnerable plaques.
Dabigatran Associated with Increased Risk of Myocardial Infarction.
Uchino and Hernandez conducted a meta-analysis of the published randomized controlled trials of dabigatran. The authors found that compared to the control group medications, use of dabigatran was associated with significantly higher rates of myocardial infarction. In an accompanying comment, Rita Redberg, editor of the Archives of Internal Medicine, summarizes several concerns about the use of dabigatran. Two publications are listed below.
Dabigatran and Increased Myocardial Infarctions in the RE-LY Trial.
An updated analysis of data from the RE-LY trial (a trial of dabigatran verus warfarin in patients with atrial fibrillation), showed increased rates of myocardial infarction with dabigatran versus warfarin. The findings were consistent across various study subgroups. Although the study authors suggest an overall net benefit in use of dabigatran versus warfarin among AF patients, the increased number of myocardial infarctions warrants further investigation.
Prothrombin Complex Concentrate for Reversing the Effects of Novel Anticoagulants.
Eerenberg et al. studied the reversibility of the anticoagulant effects of dabigatran and rivaroxaban in a small randomized trial of 12 subjects. Patients were randomized to receive prothrombin complex concentrate (PCC) or saline for reversing the anticoagulant effects of the drugs. The authors concluded that PCC could successfully reverse the anticoagulant effects of rivaroxaban but not those of dabigatran. Even though the very small number of enrollees, the methodology for the cross over and the clinical setting to test PCC pose limitations to the study, it provided valuable information for strategies to stop bleeding in patients taking novel anticoagulants. In an accompanying editorial, Elizabeth Battinelli, from the Brigham and Women’s Hospital and Harvard Medical School, suggests that drug discontinuation, mechanical compression, surgical hemostasis, and transfusion of blood products would be the available options to restore normal hemostasis. Activated charcoal and dialysis (only for dabigatran) could be used in cases of acute overdose. PCC might be an option for patients taking rivaroxaban who suffer from a bleeding event, although its use needs further clinical investigation. Two publications are listed below.
Meta-Analysis Suggests the Superiority of Radial Approach for STEMI Patients Undergoing PCI.
A recent meta-analysis by Mamas et al. showed a marked reduction in mortality, major adverse cardiovascular events (MACE), as well as reduced access site complications and bleeding in patients with ST-elevation myocardial infarction who undergo transradial percutaneous coronary intervention.
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