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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Jun 10, 2019

What do Judas Priest, surfing, and clots have in common? They are the passionate interests of expert Dr. Michael Streiff who guides us through the diagnosis and management of DVT and PE aka venous thromboembolism (VTE). By the end of the episode you will know how to catch a clot very Wells! We dive deep into the treatment options, literature, and some unique cases. ACP members can claim CME-MOC credit at (CME goes live at 0900 ET on the episode’s release date).

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  • Written and produced by (including CME questions): Justin Berk MD, MPH, MBA
  • Cover art by: Kate Grant MBChB DipGUMed
  • Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
  • Edited by: Matthew Watto, MD, FACP
  • Guest:  Michael Streiff MD

Time Stamps

  • 00:00 Intro, disclaimer and guest bio
  • 04:40 Guest one-liner, book and music recommendations, advice about rejection, how to think about studies
  • 11:15 A case of DVT and some basic terminology
  • 15:37 Which DVT risk factors are most important?
  • 18:40 Use of the Wells score and D-dimer testing; should we use an age adjusted D-dimer; What about the YEARS criteria
  • 22:55 Classifying DVT; determining need and duration of anticoagulation [distal (calf vein) DVT, proximal DVT]; brief discussion of IVC filters & catheter directed therapies
  • 27:56 IVC filters for trauma
  • 29:30 Upper extremity DVT
  • 33:12 Proximal vs whole leg ultrasound for diagnosis of DVT
  • 36:25 A case of pulmonary embolism; how to diagnose pulmonary embolism and a bit on V/Q scans
  • 40:35 PESI score and HESTIA criteria
  • 42:05 Summary of how to diagnose DVT and PE
  • 43:34 Choice of initial anticoagulation
  • 45:29 DOACs for cancer
  • 48:14 DOACs for patients with very high or very low BMI
  • 49:33 Why apixaban is Dr Streiff’s favorite DOAC?
  • 51:20 Duration of therapy for DVT and PE
  • 53:33 Unprovoked DVT/PE: Risk scoring models
  • 57:52 Is thrombophilia workup necessary?
  • 58:28 Antiphospholipid antibody syndrome
  • 59:58 An extensive cancer workup is unnecessary
  • 60:33 Subsegmental pulmonary embolism: To treat or not to treat
  • 61:49 Apixaban dosing in CKD and ESRD
  • 63:51 AUGUSTUS trial for dual versus triple therapy
  • 64:52 Plug for National Blood Clot Alliance “Stop the Clot”; Anticoagulation Forum website; new 2019 ASH guidelines
  • 66:35 Outro
  • 68:00 Post credit scene