Rebecca Chanda

Anticoagulation & VTE specialist pharmacist @GSTT. VTE ambassador-Thrombosis UK. UKCPA HAT Chair. Running & hot yoga fiend. Film buff. All views are my own.

[Rebecca Chanda @BChanda6]

Great to be part of the discussions this afternoon around the current challenges faced in VTE prevention. Also a wonderful forum for sharing ideas on how to make improvements in the current political environment. @JoJerrome @BChanda6 @bhwords @lynbrownmp @FrancesAkor @EveKnight_

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

At #NTW21 Dr Josie Jenkins tells how she has championed VTE prevention in psychiatric in-patients after one of her pts died of PE. She went on to make a national difference. She has mentored other healthcare professionals who are doing the same.
#VTEleadership
#thankyou

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

VTE risk factors for psychiatric patients are different from other hosp pts
Risk factors include:
-Catatonia
-Physical restraint
-Sedation
-Anti psychotics
@sabpNHS has a project to design a psychiatric risk assessment tool led by Drs Josie Jenkins & Askma Mohamed
#NTW21

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

So agree. I am wary of setting fixed criteria of how to diagnose a new disease without fully appreciating the many ways it can present.
Some VITTs cases look ‘classic’ except might have a normal fibrinogen & slightly raised D-dimer or have everything but positive anti-PF 4

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

Discrepancies between guidelines on extended & community thromboprophylaxis for COVID-19 care fr ⁦⁦@shapiro_susie⁩ #NTW2021 symposium on thrombosis & COVID-19

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

30-40s to be offered alternative to AZ vaccine in the UK
Great news. For we have approx 9 million aged 30-39
This means on current estimates ( 1/95,000) approx 100 cases of vaccine induced immune thrombocytopenia & thrombosis (VITTs) will be prevented. https://t.co/ibRWGFG3eW

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

Loss of heparan sulphate/degradation of the endothelial glycocalyx is a marker of endothelial perturbation & seen in sepsis & other critical illness.
Here we looked at paediatric cardiac surgery & showed it was associated with metabolic acidosis https://t.co/Nr80lbZUI7

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

Exasperated to be asked by a University to give a reference for a modest & self-effacing woman. She has easily enough papers to become a full Prof. In a dept where there are 3 male & no female Profs they want her to be an Associate Prof. It’s not acceptable
@GenderAvenger

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

International experts fr @isth also agree that :

Patients with a prior history of blood clots or with a history of thrombophilia should continue to be vaccinated, (at odds with @MHRAgovuk )

&

Endorse the British Expert Haematology Panel guidance

https://t.co/7bMNNBDrgw

[Stephane Jaglin @SJaglin]

Risk Vs benefits @AstraZeneca vaccine #Covid @ThrombosisUK

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

Although the rate of thromboembolism post vaccine does not seem to be increased, within this group we are seeing thrombosis in unusual sites & with thrombocytopenia.

I am signing out of Twitter for now to devote my energies to this problem

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

At last! Submitted to @NHSEngland on April 22rd & published 2 months later, (thanks @lynbrownmp), national guidance on prevention, detection and management of VTE in patients with COVID-19 https://t.co/Gejm16HWkv

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

Game changer for Vascular Surgeons!

VOYAGER PAD = RCT of 6k+, has shown that after revascularisation for peripheral vascular disease, rivaroxaban 2.5 BD + aspirin led to ⬇️ cardiovascular events over 3 yrs vs aspirin alone but
⬆️ major bleeds https://t.co/4P0pe0meXM

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

Severe #CoVI-19 develops about 7-10 days after becoming symptomatic, & produces a v prothrombotic (sticky blood) state.
I currently asking all my thrombophilia patients to contact me via clinic (not Twitter please) if they test positive so can give anticoagulation advice

[Rebecca Chanda @BChanda6]

Thanks to Dr Susie Shapiro @shapiro_susie for an excellent overview of the evidence for and meeting the challenge of VTE prophylaxis in COVID patients

[Rebecca Chanda @BChanda6]

Excellent presentation by Dr Susie Shapiro giving rationale for VTE prophylaxis in COVID patients.

[Rebecca Chanda @BChanda6]

Excellent perspective from @RCEMprof on challenges with decision making and evaluating the emerging evidence and broader scope of treatment options that are now being considered for management if VTE in COVID in the critically ill patient!

[Thrombosis UK @ThrombosisUK]

Very challenging decision making and must be on individual basis @RCEMprof discussing #Thrombosis & #Covid_19 #webinar. Video available shortly on @ThrombosisUK website & @stemlyns blog

[Rebecca Chanda @BChanda6]

Excellent presentation by Dr Susie Shapiro giving rationale for VTE prophylaxis in COVID patients.

[UKCPA Haemostasis & Thrombosis Committee @UKCPAHAT]

Currently in the UK patients should be risk assessed and given dose adjusted #LMWH for patients weight @ThrombosisUK @bhwords

[Rebecca Chanda @BChanda6]

Excellent perspective provided here by Dr Daniel Horner. Also looking at the other options apart from heparin and latest research. V interesting discussions!

[UKCPA Haemostasis & Thrombosis Committee @UKCPAHAT]

thanks to @RCEMprof for great presentation and for the blog: https://t.co/AXMD6MTPj4 #FOAMed @ThrombosisUK

[Stephane Jaglin @SJaglin]

DVT and PE rates within patients in ICU regardless of symptoms: depends on how hard you look @ThrombosisUK @bhwords @shapiro_susie

[Professor Beverley Hunt OBE (also on BlueSky) @bhwords]

It’s difficult using standard methods to diagnose PE in severe #CoVid-19 says @RCEMprof
Problems
- can’t use D-dimer as already ⬆️
- echocardiogram can show abnormal right ventricule due to COVID itself
- segmental & subsegmrntal changes may be due to immuno thrombosis

[Rebecca Chanda @BChanda6]

Wonderful to hear @bhwords on radio 4. Definitely need more research in this area!

[Thrombosis UK @ThrombosisUK]

Good to hear @bhwords on @BBCRadio4 news speaking about #thrombosis #COVIDー19 Need to support #research in this area to understand and inform evidenced based practice