Taming the Bleed: An Algorithm for Action - Deborah Siegal & Siraj Mithoowani

CLOT Conversations

#Science #Fitness #Biology #Medicine #Thrombosis Canada

35:19

We’ve turned intuition into a buzzword—flattened it into a slogan, a gut feeling, or a vague whisper we don’t always know how to hear. But what if intuition is so much more? What if it's one of the most powerful tools we have—and we’ve just forgotten how to use it? In this episode, I’m joined by Hrund Gunnsteinsdóttir , Icelandic thought leader, filmmaker, and author of InnSæi: Icelandic Wisdom for Turbulent Times . Hrund has spent over 20 years studying and teaching the science and art of intuition through her TED Talk, Netflix documentary ( InnSæi: The Power of Intuition ), and global work on leadership, innovation, and inner knowing. Together, we explore what intuition really is (hint: not woo-woo), how to cultivate it in a culture obsessed with logic and overthinking, and why your ability to listen to yourself might be the most essential skill you can develop. In This Episode, We Cover: ✅ Why we’ve misunderstood intuition—and how to reclaim it ✅ Practical ways to strengthen your intuitive muscle ✅ What Icelandic wisdom teaches us about inner knowing ✅ How to use intuition during uncertainty and decision-making ✅ Why trusting yourself is an act of rebellion (and power) Intuition isn’t magic—it’s a deep, internal guidance system that already exists inside you. The question is: are you listening? Connect with Hrund: Website: www.hrundgunnsteinsdottir.com TedTalk: https://www.ted.com/talks/hrund_gunnsteinsdottir_listen_to_your_intuition_it_can_help_you_navigate_the_future?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare Newsletter: https://hrundgunnsteinsdottir.com/blog/ LI: www.linkedin.com/in/hrundgunnsteinsdottir IG: https://www.instagram.com/hrundgunnsteinsdottir/ Book: InnSæi: Icelandic Wisdom for Turbulent Times Related Podcast Episodes: How To Breathe: Breathwork, Intuition and Flow State with Francesca Sipma | 267 VI4P - Know Who You Are (Chapter 4) Gentleness: Cultivating Compassion for Yourself and Others with Courtney Carver | 282 Share the Love: If you found this episode insightful, please share it with a friend, tag us on social media, and leave a review on your favorite podcast platform! 🔗 Subscribe & Review: Apple Podcasts | Spotify | Amazon Music…

about a year ago 34:15

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Drs. Mithoowani and Siegal discuss new expert guidance for managing severe bleeding in patients taking oral anticoagulants, including identifying those at risk, optimizing supportive measures, treating the source of bleeding, and administering reversal agents. It includes discussion of the algorithm for use at the point of care that helps identify patients at risk of adverse outcomes, optimize supportive measures, treat the source of bleeding, and administer anticoagulant reversal or hemostatic therapies.

Abstract: http://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2464-2887
Full text HTML: http://www.thieme-connect.com/products/ejournals/html/10.1055/a-2464-2887
Full text PDF: http://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-2464-2887.pdf

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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

35 episodes

Taming the Bleed: An Algorithm for Action - Deborah Siegal & Siraj Mithoowani

CLOT Conversations

published about a year ago

MP3•Episode home

Send us a text

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

35 episodes

#Science #Fitness #Biology #Medicine #Thrombosis Canada

All episodes

CLOT Conversations

1
Reduced-Dose Apixaban for Cancer-Associated Thrombosis: A New Standard? 15:36

23 days ago15:36

15:36

Send us a text In this episode of CLOT Conversations , we sit down with Dr. Marc Carrier to explore a groundbreaking study published in the New England Journal of Medicine on reduced-dose apixaban for cancer-associated venous thromboembolism (VTE). Dr. Carrier breaks down the study’s findings, which suggest that a lower dose of apixaban after six months of treatment is just as effective in preventing clot recurrence — and significantly safer in terms of bleeding risk. Tune in for expert insights on how this data could shift clinical practice and improve outcomes for patients living with cancer. Reference: Mahé I, Carrier M, Mayeur D, Chidiac J, Vicaut E, Falvo N, Sanchez O, Grange C, Monreal M, López-Núñez JJ, Otero-Candelera R. Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism. New England Journal of Medicine. 2025 Mar 29. 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…

CLOT Conversations

1
Taming the Bleed: An Algorithm for Action - Deborah Siegal & Siraj Mithoowani 34:15

15 weeks ago34:15

34:15

Send us a text Drs. Mithoowani and Siegal discuss new expert guidance for managing severe bleeding in patients taking oral anticoagulants, including identifying those at risk, optimizing supportive measures, treating the source of bleeding, and administering reversal agents. It includes discussion of the algorithm for use at the point of care that helps identify patients at risk of adverse outcomes, optimize supportive measures, treat the source of bleeding, and administer anticoagulant reversal or hemostatic therapies. Abstract: http://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2464-2887 Full text HTML: http://www.thieme-connect.com/products/ejournals/html/10.1055/a-2464-2887 Full text PDF: http://www.thieme-connect.com/products/ejournals/pdf/10.1055/a-2464-2887.pdf 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…

CLOT Conversations

1
Saving Money, Saving Lives: The Impact of Anticoagulation Stewardship - Dr Tony Wan 20:45

21 weeks ago20:45

20:45

Send us a text Dr Tony Wan shares the results of a study that examined the effectiveness of an anticoagulation stewardship program (ACSP) in improving adherence to venous thromboembolism (VTE) prophylaxis guidelines and reducing costs at a Canadian teaching hospital. Here what he has to say about the results and the process of setting up the study in his hospital. Tony Wan, Stephanie J. Garland, Chipman Taylor Drury, Justin Lambert, Joshua Yoon, Melissa Chan, Anticoagulation stewardship: Improving adherence to clinical guidelines and reducing overuse of venous thromboembolism prophylaxis in hospitalized medical patients, Thrombosis Research, Volume 239, 2024, https://www.sciencedirect.com/science/article/pii/S0049384824001622 Donate to Thrombosis Canada: https://thrombosiscanada.ca/donate 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…

CLOT Conversations

1
Canadian Stroke Best Practices - CVT 32:29

24 weeks ago32:29

32:29

Send us a text An insightful conversation with co-authors Dr Thalia Field and Dr Jennifer Mandzia on the Canadian Stroke Best Practices 7th edition, Cerebral Vein Thrombosis. Hear from two of the guideline's authors about the latest recommendations on management of CVT. For a copy of the publication click here: Publication Link 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…

CLOT Conversations

1
ANNEXA-4 G.I. Sub-analysis - Dr Deborah Siegal 23:56

41 weeks ago23:56

23:56

Send us a text Dr Deborah Siegal joins us for a discussion on the recent paper, The Efficacy and Safety of Andexanet Alfa in Patients With Acute Gastrointestinal Bleeding While Taking Factor Xa Inhibitors: An ANNEXA-4 Sub-analysis. In this wide-ranging discussion she reviews the results of the sub-analysis and the need for anticoagulant reversal for acute GI bleeding. This discussion provides her perspective on the issue of bleeding with DOACs and the challenges in patient management. Dr. Deborah Siegal MD MSc FRCPC is a clinician-scientist hematologist (thrombosis medicine) at The Ottawa Hospital, Associate Professor of Medicine and School of Epidemiology and Public Health at the University of Ottawa, and Scientist at the Ottawa Hospital Research Institute. Her primary research interest is improving the safety of anticoagulant therapy including optimizing the management of anticoagulant-related bleeding complications, restarting anticoagulants after bleeding, perioperative management of anticoagulants, and antithrombotic therapies for ischemic stroke in patients with cancer. Dr Siegal is a member of the board of directors of Thrombosis Canada. Reference: Siegal DM, Forbes N, Eikelboom J, Beyer-Westendorf J, Cohen AT, Xu L, Connolly SJ, Crowther M. The Efficacy and Safety of Andexanet Alfa in Patients With Acute Gastrointestinal Bleeding While Taking Factor Xa Inhibitors: An ANNEXA-4 Subanalysis. Circulation. 2024 Apr 16;149(16):1315-8. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.123.066933 Follow us on Twitter: @ThrombosisCan @debsiegal 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…

CLOT Conversations

1
ISTH 2023 COVID Guideline Update - Schulman & Sholzberg 32:51

1 year ago32:51

32:51

Send us a text This episode of CLOT Conversations features Dr Sam Schulman (Hamilton) and Dr Michelle Sholzberg (Toronto) discussing the 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19 of which they were two of the co-authors. While COVID-19 is no longer considered a global emergency, healthcare professionals continue to see critical and non-critical cases regularly. This is particularly the case in locations where medical care is challenging. There was a need to update the 2022 guidelines due to the large number of recently-published studies in the area that were not included in the 2022 edition. Consideration was given to recommendations that could be implemented globally. This is an important update to take into account when encountering patients with sever COVID illness. Reference: Schulman S, Arnold DM, Bradbury CA, Broxmeyer L, Connors JM, Falanga A, Iba T, Kaatz S, Levy JH, Middeldorp S, Minichiello T. 2023 ISTH update of the 2022 ISTH guidelines for antithrombotic treatment in COVID-19. Journal of thrombosis and haemostasis. 2024 Mar 18. 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…

CLOT Conversations

1
Pharmacokinetics of DOACS after Bariatric Surgery - Gunka & Mithoowani 20:06

1 year ago20:06

20:06

Send us a text 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. 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…

CLOT Conversations

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Spot The Clot in Cancer-associated Thrombosis - Dr Laurie Sardo & Julia Bayadinova, NP 21:55

1 year ago21:55

21:55

Send us a text 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 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…

CLOT Conversations

1
Exploring Drug-Drug Interactions in Cancer Patients - Dr Tzu-Fei Wang 26:22

1 year ago26:22

26:22

Send us a text 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 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…

CLOT Conversations

1
Post-thrombotic Syndrome and the TILE Study 28:46

1 year ago28:46

28:46

Send us a text 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 Follow us on twitter: @thrombosiscan Check out our website: https://thrombosiscanada.ca 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…

CLOT Conversations

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ISTH Interview - Dr Gregoire Le Gal interviews Dr Vicky Mai 5:59

2 years ago5:59

5:59

Send us a text 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. Join us on Twitter: @thrombosiscan @VickyMai @grelegal Visit www.thrombosiscanada.ca for more information and resources 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…

CLOT Conversations

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Interviews from the ISTH 2023 10:44

2 years ago10:44

10:44

Send us a text 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! Follow us on Twitter: @thrombosiscan 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…

CLOT Conversations

1
Statins & Post-thrombotic Syndrome - The Evidence 13:43

2 years ago13:43

13:43

Send us a text 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. Contact us on Twitter: @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. 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…

CLOT Conversations

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The HIGHLOW Study with Dr Saskia Middeldorp & Dr Hanke Wiegers 20:33

2 years ago20:33

20:33

Send us a text 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 Follow us on Twitter: @thrombosiscan @MiddeldorpS 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…

CLOT Conversations

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Thrombotic & Bleeding Outcomes following AC interruption in NVAF and Ca with Dr Joseph Shaw & Dr Tzu-Fei Wang 25:45

2 years ago25:45