CLOT Conversations

Thrombosis Canada

Unlock the latest breakthroughs in thrombosis diagnosis and management with CLOT Conversations - the must-listen podcast for healthcare professionals. Join hosts Dr Jameel Abdulrehman, a Hematologist with specialization in Thrombosis and Hemostasis at the University Health Network in Toronto, and David Airdrie, the Executive Director of Thrombosis Canada, as they delve into new research and explore the evolving field of thrombosis in 15 to 30 minute easily digestible episodes. Learn from the experts and stay ahead of the curve with Thrombosis Canada, the organization dedicated to promoting excellent patient care and improved outcomes for patients with thrombosis. Access our vast resources, tools, and programs at https://thrombosiscanada.ca and stay informed with CLOT Conversations - your go-to source for all things thrombosis.

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Episodes

Spot The Clot in Cancer-associated Thrombosis - Dr Laurie Sardo & Julia Bayadinova, NP
Feb 12 2024
Spot The Clot in Cancer-associated Thrombosis - Dr Laurie Sardo & Julia Bayadinova, NP
This podcast features an interview with Laurie Sardo and Julia Bayadinova, experts on Cancer-associated Thrombosis, from Hamilton Ontario, authors of a series of publications in the Canadian Oncology Nursing Journal on Cancer-associated Thrombosis, called Spot the Clot.Laurie Sardo is a Nurse Practitioner in the Thrombosis Service, Department of Hematology at St. Joseph's Healthcare in Hamilton. She graduated with her NP from McMaster University in 2014, and her Doctorate in Nursing Practice from D'Youville University in 2022. Laurie’s thesis work focused on patient VTE education in the high-risk cancer population.Her professional interests include patient and staff education and remains active on a number of educational interest groups including the Thrombosis Canada Patient & Family Education committee, the ISTH Nursing committee and the US-based Anticoagulation Forum.ANDJulia Bayadinova, is a nurse practitioner specializing in Thromboembolism, serving both inpatients and outpatients at St. Joseph’s Healthcare Hamilton. In 2014, Julia graduated from Ryerson University with a combined Master of Nursing and Primary Care Nurse Practitioner Program, and has since found her passion in Thromboembolism. Her research interest lies in patient education. Julia is currently in pursuit of a Doctorate of Nursing Practice degree at Post University and is completing a thesis on the importance of patient education.In this episode, the two guests review some of the key take-aways from the series of articles. The articles can be accessed here:CAT Series in Canadian Oncology Nursing Journal:The significance of VTE in cancer: Introduction of the ‘Spot the CLOT’ serieshttps://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1234Spot the CLOT’: What cancer patients want to know https://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1262Spot the CLOT’: Awareness of cancer-associated thrombosis in healthcare providershttps://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1277/1067Spot the CLOT: Treatment considerations for CAThttps://www.canadianoncologynursingjournal.com/index.php/conj/article/view/1372Support the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
Exploring Drug-Drug Interactions in Cancer Patients - Dr Tzu-Fei Wang
Jan 19 2024
Exploring Drug-Drug Interactions in Cancer Patients - Dr Tzu-Fei Wang
In Season 2, Episode 2 of CLOT Conversations from Thrombosis Canada, Dr. Tzu-Fei Wang, an associate professor and hematologist, discusses a recent study titled "The prevalence of relevant drug-drug interactions and associated clinical outcomes in patients with cancer-associated thrombosis on concurrent anticoagulation and anticancer or supportive care therapies." The study aimed to investigate drug-drug interactions (DDIs) between anticoagulants and other medications in cancer patients and their impact on clinical outcomes.High Risk of DDIs: The study found that approximately 41% of cancer patients on anticoagulation therapy had relevant drug-drug interactions, particularly with antidepressants and certain other medications.Overall, the study highlights the importance of assessing and managing drug-drug interactions in cancer patients receiving anticoagulation therapy, while also suggesting that not all DDIs necessarily lead to adverse clinical outcomes. Collaborative efforts and larger data sets are needed to better understand and address this complex issue.Reference: Wang TF, Hill M, Mallick R, Chaudry H, Unachukwu U, Delluc A, Carrier M. The prevalence of relevant drug-drug interactions and associated clinical outcomes in patients with cancer-associated thrombosis on concurrent anticoagulation and anticancer or supportive care therapies. Thrombosis Research. 2023 Nov 1;231:128-34.  https://www.sciencedirect.com/science/article/pii/S0049384823002815 Support the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
Post-thrombotic Syndrome and the TILE Study
Dec 6 2023
Post-thrombotic Syndrome and the TILE Study
The CLOT Conversation Hosts (Dr Jameel Abdulrehman and Dr Maha Othman) discuss Post-Thrombotic Syndrome and the TILE study with two of the authors of the recently published paper, Tinzaparin Lead-in to Prevent the Post-Thrombotic syndrome study protocol, Dr Jean-Phillippe Galanaud and Dr Ilia Makedonov. In the interview the authors discuss the latest research on PTS and the rationale for the TILE study.Dr Jean-Philippe Galanaud is a General Internal Medicine specialist and Thrombosis Physician. He works as a staff physician in the Department of Medicine at Sunnybrook Health Sciences Centre in Toronto; He is associate Professor of Medicine at the University of Toronto.His areas of expertise in research are in the field of the post thrombotic syndrome and of distal DVT; He is currently conducting, with Susan Kahn from McGill, 2 multicentre studies in the field of PTS; 1 on the prevention of post thrombotic syndrome with LMWH (The Tile study) and 1 on the treatment of post thrombotic syndrome with venoactive drugs (The MUFFIN study)AndDr Makedonov completed medical school at the University of Toronto, followed by internal medicine residency in Ottawa. He took a keen interest in thrombosis, doing a fellowship at Sunnybrook and receiving a grant from CanVECTOR. He research has focused on the post thrombotic syndrome as well as distal DVT and cerebral venous sinus thrombosis. He runs a thrombosis clinic at the Southlake Regional Health Centre. He has a broad clinical practice, including peri-partum and cancer associated VTE. In his spare time , he bikes and sails. He hopes to one day own a dog. Reference:  Makedonov I, Kahn S, Abdulrehman J, et al. TILE pilot trial study protocol: Tinzaparin Lead-in to Prevent the Post-Thrombotic syndrome study protocol. BMJ Open 2023;13:e064715. doi:10.1136/ bmjopen-2022-064715  Follow us on twitter: @thrombosiscan Check out our website: https://thrombosiscanada.caSupport the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
The HIGHLOW Study with Dr Saskia Middeldorp & Dr Hanke Wiegers
Mar 17 2023
The HIGHLOW Study with Dr Saskia Middeldorp & Dr Hanke Wiegers
In this episode of CLOT Conversations we interview Dr Saskia Middeldorp and Dr Hanke Wiegers, authors of the groundbreaking Highlow study. This open-label, multicenter, randomized controlled trial aimed to determine the optimal dose of low-molecular-weight heparin (LMWH) for pregnant and postpartum women with a history of venous thromboembolism (VTE). Discover the study's findings on the incidence of recurrent VTE, major bleeding, and death from any cause between the intermediate-dose (ID) and low-dose (LD) LMWH groups. The results may surprise you and highlight the need for individualized dosing strategies for pregnant and postpartum women to balance the risks and benefits of anticoagulant therapy. Don't miss this fascinating episode!Dr Saskia Middeldorp is Professor of Medicine and Head of the Department of Internal Medicine of the Radboud University Medical Center in Nijmegen, The Netherlands. Prior to her transfer to Nijmegen in January 2021, she has been a professor of Medicine at Amsterdam University Medical Centers for over 10 years, leading the clinical thrombosis and haemostasis research lines of the Department of Vascular Medicine. Since January 2023, Saskia Middeldorp is one of the 4 Research Domain Leaders in the Radboudumc Research Institution for Medical Innovation.Her present research focuses on several aspects of hereditary and acquired thrombophilia, women’s issues in thrombosis and haemostasis, and the clinical evaluation of new anticoagulants and antidotes.Dr Hanke Wiegers is an MD, PhD student, at the department of vascular medicine at the Amsterdam UMC, location AMC. In June 2019 she started her PhD trajectory under the supervision of Prof. Dr. S. Middeldorp as supervisor and focuses particularly on women & thrombosis. On the 17th of March 2023 she will defend her PhD thesis entitled: “Progress in prevention and prediction of venous thromboembolism in women – focus on pregnancy and the postpartum period.”  Hanke Wiegers started as a gynecologist in training on the 1st of January 2023 Bistervels, I. M., Buchmüller, A., Wiegers, H. M., Áinle, F. N., Tardy, B., Donnelly, J., ... & Zelis, M. (2022). Intermediate-dose versus low-dose low-molecular-weight heparin in pregnant and post-partum women with a history of venous thromboembolism (Highlow study): an open-label, multicentre, randomised, controlled trial. The Lancet, 400(10365), 1777-1787 Follow us on Twitter:@thrombosiscan@MiddeldorpSSupport the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
DOACs vs VKAs in thrombotic APS - Dr Jean Connors & Dr Behnood Bikdeli
Feb 3 2023
DOACs vs VKAs in thrombotic APS - Dr Jean Connors & Dr Behnood Bikdeli
In this interview, two of the authors of the paper Direct oral anticoagulants vs vitamin-K antagonists in thrombotic antiphospholipid syndrome: meta-analysis of randomized controlled trials, Dr Jean Connors and Dr Benhood Bikdeli, provide listeners with an overview of their systematic review and meta-analysis that evaluated the efficacy and safety of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) in patients with thrombotic antiphospholipid syndrome. The authors searched through three databases (PubMed, EMBASE, and Cochrane Central Register of Controlled Trials) and found four eligible randomized controlled trials with a total of 472 patients. Our podcast guests discuss the results of the study and the clinical implications.  About our guests:Dr Jean M Connors: Jean M. Connors, MD is a hematology attending at Brigham and Women’s Hospital and Dana-Farber Cancer Institute; the Medical Director of the Anticoagulation Management Services, and the Hemostatic Antithrombotic Stewardship Program; and an Associate Professor of Medicine at Harvard Medical School. She received a medical degree from The Johns Hopkins University in Baltimore, completed her residency in internal medicine at Beth Israel Deaconess Medical Center in Boson, as well as fellowships in transfusion medicine and hematology & oncology from Brigham and Women’s Hospital.Dr. Connors is an Associate Editor for the Journal of Thrombosis and Haemostasis and the Journal of the American College of Cardiology: Basic to Translational Science. She is a member of or holds a leadership role in many professional societies, including ASH and ISTH. She has participated in numerous clinical trials for patients with venous thrombosis in cancer, and anticoagulation questions in general.Dr Benhood Bikdeli:Behnood Bikdeli, MD, MS is a clinician-investigator, with training in cardiology and in vascular medicine who is particularly interested in thrombotic diseases. He is an Associate Physician in the Division of Cardiovascular Medicine at Brigham and Women’s Hospital, an Instructor in Medicine at Harvard Medical School, and an investigator at Yale Center for Outcomes Research and Evaluation (CORE). His research has been funded by the NIH, the American Heart Association, Brigham and Women’s Hospital and others. Dr Bikdeli has coauthored over 180 publications, which have been published in journals including Lancet, JAMA, JAMA Internal Medicine, Circulation, Journal of the American College of Cardiology, the British Medical Journal, and others. Dr. Bikdeli was the lead author of two international consensus documents related to thrombosis in COVID-19, is the joint principal investigator of the INSPIRATION/ INSPIRATION-S randomized controlled trial, and is an Associate Editor for Thrombosis Research. Ref:Khairani, C. D., Bejjani, A., Piazza, G., Jimenez, D., Monreal, M., Chatterjee, S., ... & Bikdeli, B. (2022). Direct oral anticoagulants vs vitamin-K antagonists in thrombotic antiphospholipid syndrome: meta-analysis of randomized controlled trials. Journal of the American College of Cardiology.Follow us on Twitter:@thrombosiscan@connors_mdSupport the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
Antithrombotic Stewardship with Dr Maral Koolian & Ryan Kerzner
Jan 19 2023
Antithrombotic Stewardship with Dr Maral Koolian & Ryan Kerzner
Are you curious about how to improve the safety and effectiveness of anticoagulant prescriptions for hospitalized patients? Join us for an exclusive interview with two of the authors (Dr Maral Koolian and Pharmacist Ryan Kerzner ) of a groundbreaking study on anticoagulation stewardship program at the Montreal Jewish General Hospital. Our guests will share their findings on the success rate of recommendations made by a multidisciplinary team of physicians and pharmacists, as well as the most common types of adjustments made to prescriptions. Don't miss this opportunity to learn more about the potential benefits of these programs and the future research needed to fully understand their impact on patient outcomes. Download this episode today!Koolian, M., Wiseman, D., Mantzanis, H., Kampouris, N., Kerzner, R. S., & Kahn, S. R. (2022). Anticoagulation stewardship: Descriptive analysis of a novel approach to appropriate anticoagulant prescription. Research and Practice in Thrombosis and Haemostasis, 6(6), e12758. Guest Biographies: Dr Maral Koolian is an Assistant Professor of Medicine and the Director of the Adult Thrombosis Medicine AFC program at McGill University. She is a member of the Division of General Internal Medicine and the Centre of Excellence in Thrombosis and Anticoagulation Care (CETAC) at the Jewish General Hospital. She earned her medical degree at McGill University, where she subsequently completed post-graduate subspecialty training in General Internal Medicine. She then completed a 1-year clinical thrombosis fellowship at the University of Ottawa, followed by an MSc in Quality Improvement and Patient Safety at the University of Toronto. Her main research focus is quality improvement principles as they apply to venous thromboembolic disease and anticoagulation management. Ryan Kerzner graduated with a Bachelor of Pharmacy and a Masters in hospital pharmacy from the Université de Montréal. He has been a pharmacist at the Jewish General Hospital in Montreal since 2008. He is one of the co-founders of the hospital's Antimicrobial Stewardship programs, in which he is still actively involved. He also works in Internal Medicine where he developed an interest in Thrombosis medicine. He officially joined the hospital's CETAC team in 2019, which is the Centre of Excellence in Thrombosis & Anticoagulation Care. In CETAC, with Dr Koolian and 2 other thrombosis pharmacists, he was involved in the development an Anticoagulation Stewardship Program. Follow us on Twitter@thrombosiscan@MKoolian@Pharmacist_MTLCheck out the resources on https://thrombosiscanada.caSupport the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
Diagnosis & Mgmt of SCPCD with Dr M Othman & Dr L Brandao
Jan 6 2023
Diagnosis & Mgmt of SCPCD with Dr M Othman & Dr L Brandao
In this episode we interview two of the authors of a recent paper, Diagnosis and management of severe congenital protein C deficiency (SCPCD): Communication from the SSC of the ISTH, Dr Maha Othman and Dr Leonardo Brandao on this paper from the Journal of Thrombosis and Haemostasis. 2022;20:1735–1743. Severe congenital protein C deficiency (SCPCD) is rare and there is currently substantial variation in the management of this condition. A joint project by three Scientific and Standardization Committees of the ISTH was developed to review the current evidence and help guide on diagnosis and management of SCPCD.About our guests:Dr. Maha Othman is a clinical pathologist/hematologist with specialized training in haemostasis laboratory testing and molecular genetics of bleeding disorders. She obtained her medical degree and MSc in Clinical Pathology in Mansoura University in Egypt. She then completed her PhD in Pathology from Southampton University, UK. After this, she pursued post-doctoral research training in molecular genetics of hemophilia and von Willebrand disease with Dr. David Lillicrap, at Queen’s University, Canada. Dr. Othman is currently a full Professor at the School of Medicine, Queen’s University and at St Lawrence College, Kingston, Ontario. Her research interests include the clinical and molecular aspects of von Willebrand disease and platelet disorders particularly PT-VWD, and thromboelastography assessment of coagulopathies in women, pregnancy and cancer. She has more than 100 research papers and her research is recognized internationally. She is an editor for Seminars in Thrombosis and Haemostasis and Research and Practice in Thrombosis and Haemostasis Journals. She is a reviewer for a number of Haemostasis journals and a member of several scientific organizing committees on women’s health, and advisory boards for international haemostasis conferences. She is the previous Chairman of the Scientific and Standardization Committee (SSC) on Women’s Health Issues in Thrombosis and Haemostasis of the ISTH and currently CO-Chair on the SSC for DIC. She is a passionate educator and mentor and an advocate for rare bleeding disorders and bleeding and clotting disorders in women.Dr. Leonardo Brandão  is a native Brazilian who joined the staff at The Hospital for Sick Children in 2004. Since 2019, he has been the Thrombosis Program director. He obtained his medical degree at the University of São Paulo (USP) School of Medicine (FMUSP) before moving to North America, where he completed his post-graduate training (Paediatrics Residency at Emory University, Atlanta/GA, Paediatric Haematology/Oncology fellowship at St. Jude Children's Research Hospital, Memphis/TN, and a second fellowship in Paediatric Coagulation at Weill Cornell University, New York/NY). After finishing his training, he moved to Canada to focus on the field of paediatric thrombosis at SickKids. He is the past-chair of the thrombosis committee for the Canadian Pediatric Thrombosis Hemostasis Network (CPTHN), past-Canadian representative-elect for the Hemostasis and Thrombosis Research Society (HTRS), past-member of the first paediatric venous thromboembolism panel for the American Society of Hematology (ASH), past-co-chair of the paediatric thrombosis subcommittee for the International Society on Thrombosis and Hemostasis (ISTH), and a member of Thrombosis Canada. Links:Thrombosis Canada Clinical Guide:Support the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
Br J Haem VTE & COC Review and Meta-analysis Abdulrehman & Skeith
Sep 16 2022
Br J Haem VTE & COC Review and Meta-analysis Abdulrehman & Skeith
Two of the co-authors (Dr Jameel Abdulrehman and Dr Leslie Skeith) of the recently published review and meta-analysis, "Recurrence after stopping anticoagulants in women with combined oral contraceptive-associated venous thromboembolism: A systematic review and meta-analysis" (https://doi.org/10.1111/bjh.18331) discuss the clinical relevance of the results and implications for managing risk for women who have experienced a VTE while on combined oral contraceptives. Dr. Jameel Abdulrehman is a Hematologist and clinician investigator with specialization in Thrombosis and Hemostasis at the Toronto General Hospital within the University Health Network and assistant professor at the University of Toronto. He completed medical school at the University of Alberta, Internal Medicine residency at Western University, Hematology residency at the University of Alberta, a fellowship in thrombosis and hemostasis at the University of Toronto, and a masters in clinical epidemiology at McMaster University. He is an early career investigator with research interests in clinical studies in the use anticoagulation in special populations. He is also the regular co-host of this podcast. And Dr Leslie Skeith:Dr. Leslie Skeith is a Associate Professor in the Division of Hematology & Hematological Malignancies at the University of Calgary. She completed her medical school and Hematology residency training at the University of Calgary, and completed a 2-year fellowship in Thrombosis Medicine at the University of Ottawa. Dr. Skeith's research interest is in the area of pregnancy and venous thromboembolism, as well as medical education. She is currently completing a Master of Health Professions Education (MHPE) degree at the University of Chicago at Illinois (UIC).Follow us:@thrombosiscan@leslieskeithReference:Abdulrehman J, Elbaz C,Aziz D, Parpia S, Fazelzad R, Eischer L, et al. Recurrence after stopping anticoagulants in women with combined oral contraceptive-associated venous thromboembolism: A systematic review and metaanalysis. Br J Haematol. 2022;00:1–13. https://doi.org/10.1111/bjh.18331Support the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
2022 CHEST Perioperative Guidelines with Dr J Douketis
Aug 26 2022
2022 CHEST Perioperative Guidelines with Dr J Douketis
In this episode we will be discussing a recent paper published in CHEST entitled Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline with lead author Dr Jim Douketis. Dr. Douketis is Staff Physician in General Internal Medicine and Clinical Thromboembolism at St. Joseph’s Healthcare Hamilton. He is a Professor of Medicine and holds the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University. Dr Douketis is past-president of Thrombosis Canada.Dr. Douketis’ research interests include perioperative antithrombotic therapy, prognosis of patients with venous thromboembolism, hormonal therapy and thrombosis, prevention of venous thrombosis in medical patients, and clinical practice guideline development.Dr. Douketis is a Fellow of the Canadian Academy of Health Science, Past-President of Thrombosis Canada, Associate Editor of McMaster Textbook of Internal Medicine, Editor-in-Chief of Canadian Journal of General Internal Medicine, Deputy Editor of Annals of Internal Medicine ACP Journal Club, and Associate Editor of Thrombosis and Haemostasis. He has over 350 peer-reviewed publications.Follow us on Twitter;Thrombosis Canada: @ThrombosisCanReference:Douketis JD, Spyropoulos AC, Murad MH, Arcelus JI, Dager WE, Dunn AS, Fargo RA, Levy JH, Samama CM, Shah SH, Sherwood MW. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2022 Aug 11.Support the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada
mRNA COVID Vaccines & VTE with M Nicholson and N Chan
Jul 28 2022
mRNA COVID Vaccines & VTE with M Nicholson and N Chan
In this episode have a conversation with Dr Matthew Nicholson and Dr Noel Chan on their recent publication from Blood Review entitled No apparent association between mRNA COVID-19 vaccination and venous thromboembolism (https://www.sciencedirect.com/science/article/pii/S0268960X22000443) which was co-authored by Dr Hadi Goubran and Dr Deborah Siegal.Dr. Matthew Nicholson is a Clinical Hematologist at the Saskatoon Cancer Centre and an Assistant Professor in the College of Medicine at the University of Saskatchewan. He obtained his MD and Internal Medicine residency at the University of Saskatchewan in Saskatoon. Dr. Nicholson completed his Hematology fellowship training at the University of British Columbia in Vancouver and completed a clinical fellowship in thrombosis medicine through McMaster University, and is board certified in Internal Medicine and Hematology. Dr. Nicholson has acted as an advocate for improved training conditions for medical students and residents during his time with provincial health organizations and the resident doctors of Canada board. He co-authored the resident Doctors of Canada "Data Collection and Learner Privacy Principles" which have been adopted to help govern learner privacy rights in medical colleges and medical licensing bodies across Canada.His research interests include Venous Thromboembolism (VTE), thromboprophylaxis, and hemophagocytic lymphohistiocytosis (HLH).ANDDr Noel Chan, is an Assistant Professor in the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton ON, Canada, specializing in anticoagulant therapy and thrombosis medicine. His research seeks to improve our understanding of the triggers for thrombosis (including the role of inflammation) and the determinants of variable response to antithrombotic therapies to inform on novel strategies with the potential to further reduce the burden of thrombosis.Follow us on Twitter:Dr Matthew Nicholson: @Matt_BloodMDThrombosis Canada: @ThrombosisCanReference:Nicholson, M., Goubran, H., Chan, N., & Siegal, D. (2022). No apparent association between mRNA COVID-19 vaccination and venous thromboembolism. Blood Reviews, 100970.Support the Show.https://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada