Clot, Clot, Who's There?

More tools. New evidence. Tough decisions. With the 2026 AHA/ACC pulmonary embolism (PE) guidelines as a backdrop, when is anticoagulation enough, and when is it time to reach for advanced therapy? Behnood Bikdeli, Jane Leopold, Lisa Moores, and Suresh Vedantham return to take on the treatment questions that follow risk assessment. From fibrinolysis and mechanical thrombectomy to extracorporeal membrane oxygenation (ECMO), the panel weighs what the trials tell us, where uncertainty remains, and what matters at the bedside. Two patient cases put bleeding risk, clot anatomy, clinical trajectory, resources, and patient preferences into the mix. Episode chapters 00:00 Welcome and the Advanced PE Therapy Toolkit 03:06 Fibrinolysis and Thrombectomy: What the Trials Show 11:25 ECMO and Immediate Priorities in High-Risk PE 16:55 Choosing an Intervention: Bleeding Risk, Anatomy, and Resources 20:09 Case Discussions: Anticoagulation Alone or Advanced Therapy? 27:31 Practical Takeaways Thank you to our sponsor, Penumbra, for their generous support of this podcast episode. All content was independently developed by Vasculearn Network and the expert panel. Missed the first conversation? Check out Part 1: PE Risk Stratification to explore the new framework and how to spot patients who may be heading toward trouble.

The blood pressure looks reassuring, but is it telling the whole story? In acute pulmonary embolism (PE), the next few hours can matter as much as the first set of vital signs. Behnood Bikdeli joins experts Jane Leopold, Lisa Moores, and Suresh Vedantham to unpack the 2026 AHA/ACC PE guidelines and put the new risk-stratification framework to work. With two patient cases and practical bedside insights, the panel explores who needs a closer watch, when to mobilize a response team, and how to stay ahead of a patient who may be heading in the wrong direction. Episode chapters 00:00 The New PE Risk-Stratification Framework 06:21 Assessing Risk: Vital Signs, Biomarkers, Imaging, and Scores 11:22 Turning Risk Assessment Into Action: PERT, Monitoring, and Preparedness 18:47 Timing, Resources, and Transfer Decisions 21:59 Case 1: A Stable Presentation With Signs of RV Strain 27:32 Case 2: Transient Hypotension, Closer Monitoring, and Acute-on-Chronic Clues Thank you to our sponsor, Penumbra, for their generous support of this podcast episode. All content was independently developed by Vasculearn Network and the expert panel. What comes after risk assessment? Check out Part 2, where the panel weighs the evidence behind advanced therapies and tackles when—and how—to intervene.

GLP-1s are transforming the treatment of diabetes and obesity, but could their benefits extend to venous thromboembolism (VTE)? And what should clinicians tell patients with a history of VTE? Join host Julia Sandrin Gauer and experts Christian Ruff and Rushad Patell as they discuss: • What current evidence suggests about GLP-1 therapies and VTE risk • The limitations of existing clinical trial and observational data • Whether GLP-1 and multi-incretin therapies may have different effects • What these findings mean for clinical practice, and the questions that remain Tune in now to this special collaboration between the ISTH Pulse Podcast and Vasculearn Network's Clot, Clot, Who's There?, for this timely conversation!  

Your patient is bleeding or needs urgent surgery, but no one knows when the last DOAC dose was taken. Is there still enough factor Xa inhibitor on board to change what happens next? Join experts Alex Spyropoulos, Christopher Baugh, and Deborah Siegal as they discuss: • Why stabilization must come before laboratory confirmation • The limitations of routine coagulation tests • How to interpret drug-specific and heparin-calibrated anti-Xa assays • Practical pathways for major bleeding and urgent surgery • The future of rapid point-of-care testing Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations in thrombosis, hemostasis, and vascular medicine. 00:00: Assessing Residual Factor Xa Activity 03:41: Stabilize First, Test Second 08:56: Lab Testing: Options and Limitations 18:20: Major Bleeding vs. Urgent Surgery 21:54: The Future of Point-of-Care Testing Thank you to our sponsor, VarmX, for their generous support of this podcast episode.  Check out the companion learning course, No Time To Wait: Urgent Situations in Patients on Factor Xa Inhibitors, here.   

Factor Xa inhibitors have transformed anticoagulation, but urgent bleeding or surgery may require decisions before clinicians know when the last dose was taken or how much anticoagulant activity remains. Join experts Alex Spyropoulos, Eduardo Ramacciotti, and Preston Hewgley as they discuss: • Why residual factor Xa inhibitor activity matters in urgent care • How an unknown last dose complicates clinical decisions • Why bleeding risk persists despite DOAC advantages over warfarin • How to balance bleeding, thrombosis, and surgical urgency Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations in thrombosis, hemostasis, and vascular medicine.  00:00: Residual Factor Xa Activity: Why It Matters 01:38: Unknown Last Doses and Urgent Decisions 09:47: Major Bleeding and Urgent Surgery 14:03: Reversal, Treatment Delays, and Outcomes Thank you to our sponsor, VarmX, for their generous support of this podcast episode.  Check out the companion learning course, No Time To Wait: Urgent Surgery in Patients on Factor Xa Inhibitors, here.