After a hiatus over the summer, IM Journal Club is back! Today’s topic might be both very familiar but also somewhat mysterious to all who treat patients in hospitals: deep vein thrombosis (DVT) prophylaxis with subcutaneous injections (daily or more frequent shots). A new network meta-analysis with one slightly different endpoint was published a few months ago in the BMJ – will it end up changing everything?

Our guest speaker couldn’t be more qualified to talk about the new DVT study. Dr. Anthony C. Breu is a Hospitalist at the VA in Boston and an Assistant Professor at Harvard Medical School. He became well known in the med ed community for his tutorials on Twitter ("tweetorials") and for co-editing the Journal for Hospital Medicine’s Things We Do For No Reason series. Together with Drs. Hannah Abrams and Avraham Cooper, he hosts the Curious Clinicians Podcast where he asks "why" a lot.

0:00 Intro

0:34 Plugs

1:10 Why Should Clinicians be Curious?

2:31 Today's Study

22:30 Ben's Take-aways and Outro

References:

-Dr. Breu’s Twitter: https://twitter.com/tony_breu

-Tweetorial on κ/λ ratio in end-stage renal disease: https://twitter.com/tony_breu/status/1572231208599277568

-The Curious Clinicians. A Medical Podcast that asks “Why”? https://curiousclinicians.com/

-RJ Eck, T Elling, AJ Sutton et al. Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: systematic review and network meta-analysis. BMJ 2022;378:e070022 https://www.bmj.com/content/378/bmj-2022-070022

-Things We Do For No Reason series: https://twitter.com/twdfnr

Risk stratification tools:

- Check your electronic health record (EHR) system and consider using the built-in system (if there is one)

- S Barbar et al: A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost . 2010 Nov;8(11):2450-7 https://pubmed.ncbi.nlm.nih.gov/20738765/

-M Vardi et al: Venous thromboembolism and the utility of the Padua Prediction Score in patients with sepsis admitted to internal medicine departments. J Thromb Haemost. 2013 Mar;11(3):467-73. https://pubmed.ncbi.nlm.nih.gov/23279085/

-Calculator for the Padua Prediction Score for Risk of VTE: https://www.mdcalc.com/calc/2023/padua-prediction-score-risk-vte

- P Chopard, D Spirk, H Bounameaux: Identifying acutely ill medical patients requiring thromboprophylaxis. J Thromb Haemost. 2006 Apr;4(4):915-6. https://pubmed.ncbi.nlm.nih.gov/16634771/

-M Nendaz et al.: Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost. 2014 Mar 3;111(3):531-8. https://pubmed.ncbi.nlm.nih.gov/24226257/

-Calculator for the Geneva Risk Score for Venous Thromboembolism (VTE) Prophylaxis: https://mdcalc.com/calc/10073/geneva-risk-score-venous-thromboembolism-vte-prophylaxis

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