Embedded Files
"The Clot Thickens"
Enhanced Integration of Stroke and Thrombosis Training
"The Clot Thickens"
Enhanced Integration of Stroke and Thrombosis Training
This site is dedicated to fostering close collaboration between the disciplines of Stroke and Thrombosis. Centers with expertise in Stroke and Vascular Medicine naturally care for patients with stroke and thrombotic complications. At times, there are overlapping diagnostic and treatment considerations. Other times, there is a unifying disorder or pathophysiology that naturally brings these disciplines together. In dedicated thrombosis fellowship programs we advocate for cross pollination and training by joining the stroke service for elective time. Similarly, trainees engaged in a stroke fellowship may benefit from enhanced learning and collaboration by spending some elective time on a thrombosis service. In many centers across the United States and other parts of the world there are existing Vascular Medicine programs and there is potential added value to bringing these individual programs and Stroke training together for maximal synergy and collaboration.
Herein, we provide a reference list for background reading in addition to a Podcast/audio episode on the topic of closer integration between Stroke and Thrombosis services, including how to leverage already existing expertise in Vascular Medicine. We hope that this introductory framework will kickstart the journey for closer collaboration between Stroke/Vascular Medicine/Thrombosis programs.
We hope you find this website and resources useful.
Thrombosis and Stroke Resources
Thrombosis and Stroke Resources
Supplementary Reference List: Thrombosis and Stroke Resources
General Thrombosis
Becattini C, Agnelli G. Acute treatment of venous thromboembolism. Blood. 2020 Jan 30;135(5):305-316. doi: 10.1182/blood.2019001881. PMID: 31917399.
Chan N, Sobieraj-Teague M, Eikelboom JW. Direct oral anticoagulants: evidence and unresolved issues. Lancet. 2020 Nov 28;396(10264):1767-1776. doi: 10.1016/S0140-6736(20)32439-9. PMID: 33248499.
Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet. 2016 Dec 17;388(10063):3060-3073. doi: 10.1016/S0140-6736(16)30514-1. Epub 2016 Jun 30. PMID: 27375038.
Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ. 2020 Aug 5;370:m2177. doi: 10.1136/bmj.m2177. PMID: 32759284.
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. doi: 10.1093/eurheartj/ehz405. PMID: 31504429.
Jervan Ø, Gleditsch J, Tavoly M, Klok FA, Rashid D, Holst R, Steine K, Stavem K, Ghanima W. Pulmonary and cardiac variables associated with persistent dyspnea after pulmonary embolism. Thromb Res. 2021 Feb 19;201:90-99. doi: 10.1016/j.thromres.2021.02.014. Epub ahead of print. PMID: 33662800.
Swan D, Hitchen S, Klok FA, Thachil J. The problem of under-diagnosis and over-diagnosis of pulmonary embolism. Thromb Res. 2019 May;177:122-129. doi: 10.1016/j.thromres.2019.03.012. Epub 2019 Mar 14. PMID: 30889517.
Giri J, Sista AK, Weinberg I, Kearon C, Kumbhani DJ, Desai ND, Piazza G, Gladwin MT, Chatterjee S, Kobayashi T, Kabrhel C, Barnes GD. Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association. Circulation. 2019 Nov 12;140(20):e774-e801. doi: 10.1161/CIR.0000000000000707. Epub 2019 Oct 4. PMID: 31585051.
Kimpton M, Carrier M. What's new in the prevention and treatment of cancer-associated thrombosis? Hematology Am Soc Hematol Educ Program. 2019 Dec 6;2019(1):158-166. doi: 10.1182/hematology.2019000023. PMID: 31808858; PMCID: PMC6913445.
Michaud GF, Stevenson WG. Atrial Fibrillation. N Engl J Med. 2021 Jan 28;384(4):353-361. doi: 10.1056/NEJMcp2023658. PMID: 33503344.
Thrombosis Guidelines
Lim W, Le Gal G, Bates SM, Righini M, Haramati LB, Lang E, Kline JA, Chasteen S, Snyder M, Patel P, Bhatt M, Patel P, Braun C, Begum H, Wiercioch W, Schünemann HJ, Mustafa RA. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2018 Nov 27;2(22):3226-3256. doi: 10.1182/bloodadvances.2018024828. PMID: 30482764; PMCID: PMC6258916.
Witt DM, Nieuwlaat R, Clark NP, Ansell J, Holbrook A, Skov J, Shehab N, Mock J, Myers T, Dentali F, Crowther MA, Agarwal A, Bhatt M, Khatib R, Riva JJ, Zhang Y, Guyatt G. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv. 2018 Nov 27;2(22):3257-3291. doi: 10.1182/bloodadvances.2018024893. PMID: 30482765; PMCID: PMC6258922.
Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, Hutten BA, Jaff MR, Manja V, Schulman S, Thurston C, Vedantham S, Verhamme P, Witt DM, D Florez I, Izcovich A, Nieuwlaat R, Ross S, J Schünemann H, Wiercioch W, Zhang Y, Zhang Y. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020 Oct 13;4(19):4693-4738. doi: 10.1182/bloodadvances.2020001830. PMID: 33007077; PMCID: PMC7556153.
Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, Rezende SM, Zakai NA, Bauer KA, Dentali F, Lansing J, Balduzzi S, Darzi A, Morgano GP, Neumann I, Nieuwlaat R, Yepes-Nuñez JJ, Zhang Y, Wiercioch W. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018 Nov 27;2(22):3198-3225. doi: 10.1182/bloodadvances.2018022954. PMID: 30482763; PMCID: PMC6258910.
Anderson DR, Morgano GP, Bennett C, Dentali F, Francis CW, Garcia DA, Kahn SR, Rahman M, Rajasekhar A, Rogers FB, Smythe MA, Tikkinen KAO, Yates AJ, Baldeh T, Balduzzi S, Brożek JL, Ikobaltzeta IE, Johal H, Neumann I, Wiercioch W, Yepes-Nuñez JJ, Schünemann HJ, Dahm P. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019 Dec 10;3(23):3898-3944. doi: 10.1182/bloodadvances.2019000975. PMID: 31794602; PMCID: PMC6963238.
Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, Leavitt AD, Lee AYY, Macbeth F, Morgan RL, Noble S, Sexton EA, Stenehjem D, Wiercioch W, Kahale LA, Alonso-Coello P. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv. 2021 Feb 23;5(4):927-974. doi: 10.1182/bloodadvances.2020003442. PMID: 33570602; PMCID: PMC7903232.
Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. doi: 10.1182/bloodadvances.2018024802. PMID: 30482767; PMCID: PMC6258928.
Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. doi: 10.1182/bloodadvances.2018024802. PMID: 30482767; PMCID: PMC6258928.
Cuker A, Arepally GM, Chong BH, Cines DB, Greinacher A, Gruel Y, Linkins LA, Rodner SB, Selleng S, Warkentin TE, Wex A, Mustafa RA, Morgan RL, Santesso N. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018 Nov 27;2(22):3360-3392. doi: 10.1182/bloodadvances.2018024489. PMID: 30482768; PMCID: PMC6258919.
Stroke Etiologies and Antithrombotic Treatment
Putaala J. Ischemic Stroke in Young Adults. Continuum (Minneap Minn). 2020 Apr;26(2):386-414. doi: 10.1212/CON.0000000000000833. PMID: 32224758.
May JE, Moll S. How I treat unexplained arterial thrombosis. Blood. 2020 Sep 24;136(13):1487-1498. doi: 10.1182/blood.2019000820. PMID: 32584955.
Thrombophilias
Stevens SM, Woller SC, Bauer KA, Kasthuri R, Cushman M, Streiff M, Lim W, Douketis JD. Guidance for the evaluation and treatment of hereditary and acquired thrombophilia. J Thromb Thrombolysis. 2016 Jan;41(1):154-64. doi: 10.1007/s11239-015-1316-1. PMID: 26780744; PMCID: PMC4715840.
May JE, Martin KD, Taylor LJ, Gangaraju R, Lin C. Current Practice and Clinical Utility of Thrombophilia Testing in Hospitalized Patients with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105209. doi: 10.1016/j.jstrokecerebrovasdis.2020.105209. Epub 2020 Aug 17. PMID: 33066926.
Antiphospholipid Antibody Syndrome
Devreese KMJ, de Groot PG, de Laat B, Erkan D, Favaloro EJ, Mackie I, Martinuzzo M, Ortel TL, Pengo V, Rand JH, Tripodi A, Wahl D, Cohen H. Guidance from the Scientific and Standardization Committee for lupus anticoagulant/antiphospholipid antibodies of the International Society on Thrombosis and Haemostasis: Update of the guidelines for lupus anticoagulant detection and interpretation. J Thromb Haemost. 2020 Nov;18(11):2828-2839. doi: 10.1111/jth.15047. PMID: 33462974.
Pengo V, Denas G, Zoppellaro G, Jose SP, Hoxha A, Ruffatti A, Andreoli L, Tincani A, Cenci C, Prisco D, Fierro T, Gresele P, Cafolla A, De Micheli V, Ghirarduzzi A, Tosetto A, Falanga A, Martinelli I, Testa S, Barcellona D, Gerosa M, Banzato A. Rivaroxaban vs warfarin in high-risk patients with antiphospholipid syndrome. Blood. 2018 Sep 27;132(13):1365-1371. doi: 10.1182/blood-2018-04-848333. Epub 2018 Jul 12. PMID: 30002145.
Ordi-Ros J, Sáez-Comet L, Pérez-Conesa M, Vidal X, Riera-Mestre A, Castro-Salomó A, Cuquet-Pedragosa J, Ortiz-Santamaria V, Mauri-Plana M, Solé C, Cortés-Hernández J. Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome: A Randomized Noninferiority Trial. Ann Intern Med. 2019 Nov 19;171(10):685-694. doi: 10.7326/M19-0291. Epub 2019 Oct 15. PMID: 31610549.
Myeloproliferative Neoplasms
Tefferi A, Barbui T. Polycythemia vera and essential thrombocythemia: 2021 update on diagnosis, risk-stratification and management. Am J Hematol. 2020 Dec;95(12):1599-1613. doi: 10.1002/ajh.26008. Epub 2020 Oct 23. PMID: 32974939.
Stroke and Malignancy
Shah S, Norby FL, Datta YH, Lutsey PL, MacLehose RF, Chen LY, Alonso A. Comparative effectiveness of direct oral anticoagulants and warfarin in patients with cancer and atrial fibrillation. Blood Adv. 2018 Feb 13;2(3):200-209. doi: 10.1182/bloodadvances.2017010694. PMID: 29378726; PMCID: PMC5812321.
Martinez-Majander N, Ntaios G, Liu YY, Ylikotila P, Joensuu H, Saarinen J, Perera KS, Marti-Fabregas J, Chamorro A, Rudilosso S, Prats-Sanchez L, Berkowitz SD, Mundl H, Themeles E, Tiainen M, Demchuk A, Kasner SE, Hart RG, Tatlisumak T; NAVIGATE ESUS investigators. Rivaroxaban versus aspirin for secondary prevention of ischaemic stroke in patients with cancer: a subgroup analysis of the NAVIGATE ESUS randomized trial. Eur J Neurol. 2020 May;27(5):841-848. doi: 10.1111/ene.14172. Epub 2020 Mar 11. PMID: 32056346.
Matthews A, Stanway S, Farmer RE, Strongman H, Thomas S, Lyon AR, Smeeth L, Bhaskaran K. Long term adjuvant endocrine therapy and risk of cardiovascular disease in female breast cancer survivors: systematic review. BMJ. 2018 Oct 8;363:k3845. doi: 10.1136/bmj.k3845. PMID: 30297439; PMCID: PMC6174332.
Endocarditis
Liesenborghs L, Meyers S, Vanassche T, Verhamme P. Coagulation: At the heart of infective endocarditis. J Thromb Haemost. 2020 May;18(5):995-1008. doi: 10.1111/jth.14736. Epub 2020 Feb 3. PMID: 31925863.
Podcast Episode on how to implement close collaborations between thrombosis and stroke services.
Stephanie Carlin is a critical care pharmacist at Hamilton Health Sciences. She recently completed an advanced practice pharmacy residency in thrombosis at Sunnybrook Health Sciences. Dr. Carlin is an active student and resident preceptor. Her research interests include optimization of antithrombotic use in clinical practice.
Dr. Carlin has been an active member of Ontario's Science Table during the COVID19 pandemic and sits on the Drugs & Biologics Clinical Practice Guidelines Working Group.
Over the past 25 years, Dr. Geerts has developed and participated in clinical research in all aspects of thromboembolism, including epidemiology, diagnosis, treatment and prevention. His primary interest has been in the prevention of venous thromboembolism (VTE) in high-risk patients, especially following trauma. He has performed the most comprehensive, prospective study of the risks of venous thromboembolism in trauma patients and found that they are the highest-risk group for thromboembolism in hospitals.
Subsequently, Dr. Geerts and his group conducted the first large randomized controlled trial of thromboprophylaxis in major trauma patients, by comparing subcutaneous low-dose heparin with low molecular weight heparin in a double-blinded manner. This study demonstrated that the early use of low molecular weight heparin is more efficacious than low-dose heparin in trauma patients without increasing bleeding.
His research interests extend to the implementation of knowledge about thromboembolism into clinical practice.
Houman Khosravani is appointed as a clinician in quality & innovation and assistant professor of medicine, in the division of neurology, department of medicine, University of Toronto. His interests are quality improvement at different levels of care relevant to hyper-acute stroke management and inpatient stroke services. At the level of hyperacute stroke care, his focus is on improvement of door-to-needle times for thrombolysis. He is also working on understanding and improving factors that are relevant to a successful thrombectomy program in a comprehensive stroke center. He is medical director of the inpatient stroke unit, and interested in development of stroke pathways, the overlap between internal medicine and inpatient stroke neurology, and development of a framework for excellence in comprehensive neurovascular care. Dr. Khosravani is an active member of Thrombosis Canada and interested in the implementation of stroke-best practices in the area of antithrombotics and anticoagulation.
Contact Us
Contact Us
If you are interested in collaborating, discussing how to better integrate stroke and thrombosis together, reach out to us at: info@strokeandthrombosis.org
Page updated
Report abuse