Now do it by innings caught...I bet Campy is the runaway winner.

I tried. AHA does not accept letters to the editor for Guidelines.

Agree that more data is needed which is why the AHA guidelines should not have given LMWH a 1A recommendation without data to support it. They based that on vibes and gut feeling rather than data.

Agree. Not every intermediate risk PE needs UFH. Only those who are getting or may get advanced therapy (lysis or mechanical thrombectomy). Those patients probably should be in the ICU where there are more resources for monitoring.

If you are at a small community hospital, sure, LMWH for everyone. But if you are at a major center, bolus with heparin and follow you protocol. UFH allows you to hold if you need to lyse. We also bolus UFH targeting ACT >250 during mech thrombectomy, so easier to dose when on UFH prior.

No difference in mortality between LWMH and UFH in patients with PE.

The guideline claims this meta-analysis shows LMWH reduces recurrent VTE without more bleeding, yet the referenced study (1,407 PE patients, 7 trials) found no differences in recurrent VTE, major bleeding, or mortality.

Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for the initial treatment of venous thromboembolism - PubMed This review presents moderate-quality evidence that fixed dose LMWH reduced the incidence of recurrent thrombotic complications and occurrence of major haemorrhage during initial treatment; and low-qu...

The recommendation favoring subcutaneous LMWH over intravenous UFH—even in unstable patients (generally excluded from trials)—is not supported by the cited evidence.

UFH. With a bolus. The new AHA guidelines are wrong.

There was no clinically significant difference in six minute walk distance or functional class at thirty days. No difference in death or decompensation. Difference all driven by NEWS score. Not enough to convince me intermediate risk PE needs lysis (catheter or peripheral).

March is Blood Clot Awareness Month.

Blood clots can lead to pulmonary embolism and, in some cases, CTEPH, a serious form of #PH.

If you’ve had a PE and still experience shortness of breath, fatigue or swelling, talk to your doctor about CTEPH.

Learn more: buff.ly/VSbrGdC

The A-E categories are totally made up, based on retrospective data, difficult to apply clinical trials including data toward (ie intermediate-high risk spans multiple categories), and should not serve as the basis for determining whether an intervention is warranted.

Totally agree. The ECS Risk stratification is easy to understand, correlated with PE-mortality and the basis for 20 years of clinical trials including many important studies (HI PIETHO, PE TRACT, PEERLESS 2) that are currently enrolling.

Outcome of patients with right heart thrombi: the Right Heart Thrombi European Registry Our aim was the assessment of the prognostic significance of right heart thrombi (RiHT) and their characteristics in pulmonary embolism in relation to established prognostic factors.138 patients (69 females) aged (mean±sd) 62±19 years with RiHT were included into a multicenter registry. A control group of 276 patients without RiHT was created by propensity scoring from a cohort of 963 contemporary patients. The primary end-point was 30-day pulmonary embolism-related mortality; the secondary end-point included 30-day all-cause mortality. In RiHT patients, pulmonary embolism mortality was higher in 31 patients with systolic blood pressure <90 mmHg than in 107 normotensives (42% versus 12%, p=0.0002) and was higher in the 83 normotensives with right ventricular dysfunction (RVD) than in the 24 normotensives without RVD (16% versus 0%, p=0.038). In multivariable analysis the simplified Pulmonary Embolism Severity Index predicted mortality (hazard ratio 2.43, 95% CI 1.58–3.73; p<0.0001), while RiHT characteristics did not. Patients with RiHT had higher pulmonary embolism mortality than controls (19% versus 8%, p=0.003), especially normotensive patients with RVD (16% versus 7%, p=0.02).30-day mortality in patients with RiHT is related to haemodynamic consequences of pulmonary embolism and not to RiHT characteristics. However, patients with RiHT and pulmonary embolism resulting in RVD seem to have worse prognosis than propensity score-matched controls.

Correct answer is “it depends”. May not need anything.

publications.ersnet.org/content/erj/...

Who did it better?

MATCHED! 🎉 HUGE welcome to our incoming class for the PCCM & IP Fellowship Programs!

We are profoundly honored you chose @ucsdpccm.bsky.social
We can't wait to train the next generation of leaders with you! 🫁🩺

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#MatchDay #PCCM #IP #MedEd @ucsdmedschool.bsky.social

> @newyorker.com

Massive cuts to NIH will wreak havoc on UCSD and institutions all over the country. Our regional economy will suffer. Listen to UCSD researcher Srividya explain the real cost of these cuts, and help us spread the word. 🚨

Cutting Down the Nets! ✂️🏀

UC San Diego Men’s and Women’s Basketball teams conquer the Big West! 💪🏆

#GoTritons #BigWest #UCSanDiego

If you wanted to cut waste, fraud, and abuse, you would empower the inspectors general.

If you wanted more waste, fraud, and abuse, you would fire them.

We need Pete Buttigieg as a clear messenger, more than ever.

The flying public needs answers. How many FAA personnel were just fired? What positions? And why?

a man with a beard is screaming while wearing a suit . ALT: a man with a beard is screaming while wearing a suit .

💯 agree. keep an eye on the fibrinogen it has a tendency to go really low

emcrit.org/pulmcrit/fib...

Welcome! You are invited to join a webinar: Nov. PEP Talk: Navigating Post-Thrombotic Syndrome, CTEPH & CTED. After registering, you will receive a confirmation email about joining the webinar. Post-thrombotic syndrome (PTS) is estimated to affect up to 60% of individuals with DVT.  Dr. Timothy Fernandes, pulmonologist at UC San Diego Health, joins us to discuss PTS and other complications t...

HAPPENING TOMORROW: if you’re a patient or loved one of some with blood clots, join me for the NBCA’s PEP Talk on 11/12 as we explore long-term health conditions that can occur after a DVT or PE. There is still time to register! We hope to see you for this informative session. bit.ly/Nov2024PEPTalk

I am waiting on the PE-TRACT results (interventional management vs. anticoagulation alone) looking at longer term outcomes before I send every intermediate risk PE to the lab. But for sure, mechanical thrombectomy >>CDT >> tPA peripherally.

Toxicologist here for any fluoride concerns! The amount of fluoride added to water to prevent tooth decay is so minuscule that—no matter your age, size, or health status—you would die from water poisoning long before you could ever even start getting toxicity from fluoride. Fluoridated water is safe

Welcome to everyone new to Bluesky! Here's a short (illustrated) primer that explains how Feeds work and offers a few steps you can take to get the content you want, when you want it, on your terms. There are sports feeds, Gift Link feeds, community feeds, and more! A 🧵

Welcome! You are invited to join a webinar: Nov. PEP Talk: Navigating Post-Thrombotic Syndrome, CTEPH & CTED. After registering, you will receive a confirmation email about joining the webinar. Post-thrombotic syndrome (PTS) is estimated to affect up to 60% of individuals with DVT.  Dr. Timothy Fernandes, pulmonologist at UC San Diego Health, joins us to discuss PTS and other complications t...

In honor of #CTEPH Awareness Day next week, I will be discussing longterm complications of #DVT and #PE including PTS, CTED and CTEPH. If you or a loved one has had DVT/PE and aren’t back to baseline, join me on zoom next Tuesday evening for an interactive discussion. Link ⬇️.
bit.ly/Nov2024PEPTalk