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On this episode, Pip and Rich discuss HI-PEITHO, a randomised controlled trial of catheter-directed fibrinolysis in patients presenting with intermediate risk PE. This was an industry-sponsored trial. Patients could be included if they had a ratio of RV:LV end diastolic diameter of ≥1.0 and an elevated troponin level + at least two of SBP ≤110 mm Hg, HR ≥100 bpm, or a respiratory rate of >20 breaths per minute. The primary outcome was a composite of pulmonary embolism–related death, cardiorespiratory decompensation or collapse or symptomatic recurrence of pulmonary embolism within 7 days. After randomising 544 patients, a primary-outcome event occurred in 11 patients in the intervention group and 28 in the usual care arm (relative risk, 0.39; 95% CI, 0.20 to 0.77; P=0.005). So, is this a slam dunk? Should we roll out this intervention? Here we discuss the nuances of the primary outcome finding that it was mostly driven by number of patients who had a NEWS score of 9 or more, 24 hours after randomisation. Pip and Rich debate the meaning of this outcome and much more. This is most definitely a study where reading beyond the abstract is 100% necessary! Novo Nordisk has provided sponsorship to HaemSTAR to cover the costs of the development of Don’t Just Read the Abstract initiative. Novo Nordisk has had no influence over the creation, development, or content of any of the materials available Hosted on Acast. See acast.com/privacy for more information.

In this episode, Pip and Rich discuss the C-TRACT trial: Vedantham et al. Endovascular Therapy for Post-Thrombotic Syndrome — A Randomized Trial. 2026 N Engl J Med 2026;394:2293-2304 C-TRACT (Chronic Venous Thrombosis: Relief with Adjunctive Catheter-Directed Therapy) was a phase 3, publicly funded, multicentre, open-label, assessor-blinded RCT published in NEJM that randomised 225 patients with moderate-to-severe post-thrombotic syndrome (PTS) and imaging-confirmed iliac-vein obstruction to endovascular therapy (iliac-vein stenting + enhanced antithrombotic therapy) plus standard care versus standard care alone. Key Results At 6 months, the endovascular group had a statistically significant reduction in PTS severity by the Venous Clinical Severity Score (VCSS: 8.1 vs. 10.0, adjusted difference −2.0 points; P=0.001). Quality-of-life scores also improved with a 14.5-point improvement in venous disease–specific QoL (VEINES-QOL) and a 6.1-point improvement in the SF-36 physical component summary with the intervention. However, bleeding was significantly higher in the intervention group (11.6% vs. 3.6%; P=0.03). In the episode, Pip and Rich discuss key critical appraisal points including: Modest primary endpoint difference. The 2-point VCSS difference, while statistically significant, is relatively small on a 0–30 scale. The clinical meaningfulness of this difference at the individual patient level is debatable, though the authors argue that many patients shifted to lower severity categories.Open-label design. The trial was open-label, which is a significant limitation for patient-reported outcomes like quality of life. While the primary outcome (VCSS) was assessed by blinded evaluators, the large QoL differences (which are the most compelling results) are susceptible to expectation and performance bias - a limitation the authors themselves acknowledge.Short follow-up. Results are reported at only 6 months. Stent patency, durability of benefit, and long-term safety (including stent-related complications and the consequences of enhanced antithrombotic therapy) remain unknown.The relevance of enhanced antithrombotic therapy which confounds the intervention. The endovascular arm received both stenting and additional antithrombotic therapy, making it impossible to disentangle the contribution of each component and likely explaining the higher bleeding rate.Generalisability. The trial was limited to patients with iliac-vein obstruction and moderate-to-severe PTS, a specific subset of the broader PTS population. Results should not be extrapolated to milder disease or non-iliac obstruction. Hosted on Acast. See acast.com/privacy for more information.

On this episode, Pip and Rich discuss the FRONTIER2, the phase 3 trial of Mim8 (denecimig) for prophylaxis in haemophilia A with or without inhibitors. They review the study design, efficacy and safety results, and consider where Mim8 may fit into the rapidly evolving haemophilia treatment landscape. They also explore the key unanswered question: does Mim8 offer any meaningful clinical advantage over emicizumab, or is its main benefit greater convenience through fixed-volume administration? Hosted on Acast. See acast.com/privacy for more information.

On this episode, Pip and Rich chat to Consultant Haematologist, Dr Kate Musgrave and Thrombosis Nurse Specialist, Vicky Marr about how they developed and implemented a natural language processing model that identifies cases of hospital acquired thrombosis. Implementing this strategy in their hospital in Newcastle-Upon-Tyne has led to saving thousands of hours of manually trawling radiology reports - enabling them to focus on what matters - interacting with patients. The tool is now available for implementation across the NHS. This is a must-listen for anyone wanting to improve efficiency in their hospital. Read more about the project here. Hosted on Acast. See acast.com/privacy for more information.

On this episode, Pip and Rich discuss the COBRRA trial: Castellucci et al. Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. NEJM. 2026. The trial showed a convincing reduction in clinically relevant bleeding in patients treated with apixaban (3.3% vs 7.1%) and no difference in efficacy. It's a compelling study but there were important exclusion criteria and as ever, there are some nuances beyond the abstract. This episode also includes an update on Pip's daughter's school science project where unwitting families were invited for dinner to find out whether there is, indeed, always time for pudding. Hosted on Acast. See acast.com/privacy for more information.

Following its recent US FDA approval, on this episode, Pip and Rich discuss mitapivat, an allosteric activator of red-cell pyruvate kinase. They focus on ENERGIZE, a randomised controlled trial of mitapivat vs placebo (2:1) randomisation in people living with transfusion dependent thalassaemia. It met its primary endpoint of achieving significantly more patients reaching a haemoglobin rise of at least 1 g/L. However, Pip and Rich discuss the relevance of this surrogate endpoint as well as the small effects on fatigue and quality of life. Taher et al. Mitapivat in adults with non-transfusion-dependent α-thalassaemia or β-thalassaemia (ENERGIZE): a phase 3, international, randomised, double-blind, placebo-controlled trial. Lancet. 2025 Jul 5;406(10498):33-42. doi: 10.1016/S0140-6736(25)00635-X. Hosted on Acast. See acast.com/privacy for more information.

On this episode, Pip and Rich VAY-HIT2, a trial recently published in the New England Journal of Medicine. This study randomised patients with relapsed/refractory ITP after first line corticosteroids to eltrombopag + ianalumab or placebo.   As the thrombopoietin receptor agonists such as eltrombopag are often given for extensive periods, there's a lot of interest in giving additional treatment that can result in a relatively short course of treatment. Ianalumab is an anti-B-Cell Activating Factor (BAFF) Receptor monoclonal antibody.   VAY-HIT2 was a phase 3, randomised, double-blind trial, assigning, in a 1:1:1 ratio, adults with primary ITP and an insufficient response or a relapse after first-line glucocorticoid therapy to receive eltrombopag + ianalumab at a dose of 9 mg or 3 mg per kilogram of body weight or placebo once monthly for 4 months.   The trial did meet its primary endpoint but there's a lot to discuss, most importantly the quality of life end points - and the interpretation is not straight forward! Conflict of interest disclosure here: Pip has received travel expenses and payment for attending an advisory board for Novartis. Pip is also leading a Novartis-sponsored UK audit of the treatment of warm autoimmune haemolytic anaemia on behalf of HaemSTAR (www.haemstar.org/TRUTH). Hosted on Acast. See acast.com/privacy for more information.

In this second of a two-part episode, Pip and Rich discuss their highlights of 2025. They discuss a wide range of developments across medical haematology with a focus on red cells disorders and a bit less naval gazing than the first episode. Hosted on Acast. See acast.com/privacy for more information.

In this first of a two-part episode, Pip and Rich discuss their highlights of 2025. They discuss a wide range of developments across medical haematology with a focus on bleeding disorders and immuno-haematology. Hosted on Acast. See acast.com/privacy for more information.

On this episode, Pip and Rich discuss two of their recent publications on idiopathic and secondary polycythaemia. The first is an audit across two large hospitals in the Midlands. The team screened over 2000 patients who had had a JAK2 mutation screen performed, eventually finding 266 with confirmed idiopathic or secondary polycythaemia. By the time patients were seen, the haematocrit was already dropping. 60% were never venesected and venesection seemed to make no difference to haematocrits and had no association with thrombotic events. In the second paper which was a survey of clinicans, practice was, as expected, shown to be variable. 85% responded to say that they would be willing to randomise patients to a clinical trial of venesection vs no venesection. This is an interesting discussion on a common situation for which there is almost no academic interest whatsoever. However, it is a big clinical problem - there is a lot of work for haematologists here. The evidence does not support treating this group of patients in any way shape or form and a trial to prove non-inferiority of no venesection is very much needed. Here are the links to the papers: Maybury et al. Venesection and resolution of erythrocytosis are not associated with reduced thrombotic risk in secondary and idiopathic polycythaemia: Results from a dual centre, 5-year retrospective study. Br J Haematol . 2025 Sep;207(3):1127-1132. doi: 10.1111/bjh.20235Nicolson et al. Common Themes and Uncertainties in Management of Secondary Polycythaemia: An International Clinician Survey of Practice. EJHaem . 2025 Oct 27;6(6):e70171. doi: 10.1002/jha2.70171 Hosted on Acast. See acast.com/privacy for more information.

On this episode, Pip and Rich discuss the BASIS trial which investigated the efficacy of the rebalancing agent marstacimab in people living with haemophilia. Marstacimab is an inhibitor of tissue factor pathway inhibitor (TFPI) and works by tipping the balance of clotting towards coagulation and away from bleeding. The trial showed that marstacimab works but is not randomised and there are some very interesting critical appraisal points in here even if you are not hugely interested in haemophilia. Matino et al. Marstacimab prophylaxis in hemophilia A/B without inhibitors: results from the phase 3 BASIS trial. Blood (2025) 146 (14): 1654–1663. Want a free monthly newsletter on medical haematology? Sign up at www.dontjustreadtheabstract.com. Hosted on Acast. See acast.com/privacy for more information.

In this episode, Pip and Rich chat to Dr Sue Pavord, current President of the British Society of Haematology. Over the last 18 months Dr Pavord has led from the front with serious work on defining liaison haematology, paving the way for this to be formally incorporated into haematologists' job plans. They also discuss Dr Pavord's pivotal role as a clinical leader in the UK's response to Vaccine Induced Immune Thrombosis with Thrombocytopenia (VITT). Her insight into medicine, politics, and strategy are invaluable and this is a wide ranging interview. Give it a listen, and give it a like! You can read the recent publication on Liaison Haematology, recently published in BMJ Open, here. Hosted on Acast. See acast.com/privacy for more information.

Pip and Rich preview their second Don't Just Read the Abstract newsletter. This week, the newsletter focuses on the work that the British Society for Haematology have being doing on workforce planning and liaison haematology in particular. If you would like to read Dr Sue Pavord's BSH message you can find it here. The paper we mention: Ransome et al. Defining ‘liaison haematology’ in the UK: a modified Delphi study. BMJ Open. 2025. To receive the newsletter, go to www.dontjustreadtheabstract.com and sign up. You can also access the newsletter on the website. Hosted on Acast. See acast.com/privacy for more information.

When Dr Peter Douglas listened to our episode on the PEERLESS trial (S1, Ep12), he began to develop a funny sensation in his chest. Emailing us he wrote: "Your commentary on this paper lead me to develop the signs and symptoms of submassive PE. I am an interventional radiologist who has spent the last 3-4 years setting up a PERT and catheter based therapy service for PE and would love to speak to you further about this. In a nutshell... you missed the point. But the point is not something the authors or sponsoring company were trying to prove, so you won't find it in the results section." Happily, he was joking (sort of), but it did make us want to get him on and ask him all about something we have limited personal experience of. So, we did! Hosted on Acast. See acast.com/privacy for more information.

In this 5 minute episode, Pip and Rich introduce the brand new Don't Just Read the Abstract Newsletter, a twice monthly update on all things medical haematology. Covering latest developments and publications in haemostasis, thrombosis, transfusion, immunohaematology, and red cell haematology, the newsletter will keep you up-to-date on what matters to patients. Sign up at www.dontjustreadtheabstract.com. Hosted on Acast. See acast.com/privacy for more information.