Don't Just Read the Abstract

Apixaban vs rivaroxaban: the trial we've all been waiting for

Tue, 17 Mar 2026 09:30:28 GMT

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.

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ENERGIZE: Mitapivat in thalassaemia

Fri, 27 Feb 2026 08:20:05 GMT

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.

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Ianalumab for ITP: VAYHIT2

Tue, 10 Feb 2026 11:30:48 GMT

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).

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Highlights of 2025 (Episode 2)

Fri, 09 Jan 2026 16:50:43 GMT

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.

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Highlights of 2025 (Episode 1)

Fri, 26 Dec 2025 21:28:06 GMT

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.

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Does anyone care about idiopathic and secondary polycythaemia? We do!

Tue, 09 Dec 2025 17:07:58 GMT

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:

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Rebalancing haemostasis with marstacimab - an discussion about the BASIS trial

Thu, 13 Nov 2025 13:53:32 GMT

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.

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BSH President Dr Sue Pavord: An Interview

Wed, 29 Oct 2025 15:18:16 GMT

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.

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DJRTA Newsletter #2

Wed, 22 Oct 2025 08:34:33 GMT

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.

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Intervention for Intermediate-High Risk PE

Wed, 15 Oct 2025 06:00:00 GMT

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!

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Introducing the DJRTA Newsletter

Tue, 07 Oct 2025 12:20:29 GMT

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.

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HI-PRO: Apixaban for Extended Treatment of Provoked Venous Thromboembolism

Tue, 30 Sep 2025 09:51:49 GMT

On this episode, Pip and Rich discuss Piazza et al. Apixaban for Extended Treatment of Provoked Venous Thromboembolism, published in the New England Journal of Medicine in August 2025. This trial randomised 600 patients with VTE provoked by a transient risk factor but who also had at least one enduring risk factor, after completing 3 months of anticoagulation, to receive either apixaban 2.5 mg twice daily or placebo for 12 months. Extended apixaban reduced recurrent VTE from 10.0% to 1.3% (HR 0.13, 95% CI 0.04–0.36) with very low rates of major bleeding, though clinically relevant non-major bleeding was more frequent.

The caveat to these findings is the definition of "provoked" used in the trial, which is wide-ranging. This is an insightful discussion and is highly relevant to clinical practice.

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API-CAT: Author interview with Prof. Isabelle Mahé

Mon, 15 Sep 2025 19:01:33 GMT

Prof. Isabelle Mahé is a cardiologist, triallist, and Professor of Internal Medicine Paris Cité University, France. She recently led the API-CAT study, a randomised controlled trial of apixaban 2.5 mg BD vs 5 mg BD for treatment of patients with cancer associated venous thromboembolism after 6 months of therapy. Pip and Rich discussed API-CAT in detail in episode 20 and now seize the opportunity to speak to an international expert and leader in the field about the art of the trial.

API-CAT was published in the New England Journal of Medicine in 2025,

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API-CAT: Extended Reduced-Dose Apixaban for Cancer-Associated Venous Thromboembolism

Mon, 21 Jul 2025 23:00:00 GMT

In this episode, Pip and Rich go beyond the abstract of the API-CAT study, a randomised controlled trial of apixaban 5 mg BD vs 2.5 mg BD in patients with cancer-associated PE or DVT who have completed 6 months of anticoagulation. The study reported non-inferiority for low-dose apixaban in terms of VTE recurrence with a reduction in clinical relevant bleeding. This is an interesting, practice-changing study but there is plenty of nuance and a lot to discuss. Don't miss this one!

HaemSTAR is an independent UK-wide network of registrars in clinical haematology, interested in promoting and performing research in classical haematology. Our focus is on collaborative projects across haemostasis & thrombosis, transfusion, general haematology, and obstetric haematology.

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LUNA3: Rilzabrutinib for ITP

Sun, 06 Jul 2025 16:09:43 GMT

In this episode of Don't Just Read the Abstract, Pip and Rich critically appraise LUNA3, a 2:1 randomised controlled trial of rilzabrutinib vs placebo in adults with persistent or chronic ITP. This is the first therapy to prove an improvement in fatigue in ITP, but does it live up to expectation? Listen to this episode and find out.

Do you like our show? Please share with friends, colleagues, and the wider world on social media.

References

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Haematology in The Gambia with Dr Megan Kell

Thu, 12 Jun 2025 21:33:05 GMT

Dr Megan Kell is a UK haematologist, currently practising in Sheffield. She is the Chair of the British Society of Haematology's Global Haematology Specialist Interest Group and has a long standing interest in Global Health. She recently returned from over two years working as one of only two haematologists in the small, west African nation of The Gambia. This is an eye-opening interview which makes you realise what we take for granted. There are some great stories in here about how to improvise, how to acquire what you need in a resource poor setting, and what's truly important in medicine. This is a must listen!

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Efanesoctocog alfa for severe haemophilia A: expert perspective with Dr Susie Shapiro

Fri, 30 May 2025 15:04:30 GMT

On this episode, Pip interviews Dr Susie Shapiro, consultant haematologist in Oxford, UK, about the recent UK approval of efanesoctocog alfa, a very long half-life factor VIII product for severe haemophilia. To find out more about this treatment, listen to our first episode on the subject (Efanesoctocog alfa - a very long half life factor VIII) where we discuss the evidence.

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Efanesoctocog alfa - a very long half life factor VIII

Fri, 16 May 2025 06:27:35 GMT

On this episode, Rich and Pip discuss the very long half life factor VIII product efanesoctocog alfa (trade names Altuvoct and Altuviiio). They discuss the 2023 NEJM paper that has recently prompted its approval for use in the UK NHS. This is the first of two episodes on this subject.

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BSH Day 2

Mon, 28 Apr 2025 23:09:00 GMT

Pip and Rich discuss the happenings from day 2 of the British Society of Haematology Annual Scientific Meeting.

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BSH Day 1

Sun, 27 Apr 2025 23:23:13 GMT

On this show, Pip and Rich discuss the first day of BSH, focusing on medical haematology.

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Preview of BSH 2025: a focus on medical haematology

Fri, 18 Apr 2025 02:30:10 GMT

In this episode, Rich and Pip review the programme for BSH 2025 and discuss the non-malignant haematology sessions not to miss. This is your go to guide for Glasgow 2025 beginning on 27th April.

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PEERLESS - Management of Acute Intermediate-Risk PE

Fri, 04 Apr 2025 19:27:39 GMT

On this episode, Pip and Rich discuss Jaber et al. Large-Bore Mechanical Thrombectomy Versus Catheter-Directed Thrombolysis in the Management of Intermediate-Risk Pulmonary Embolism: Primary Results of the PEERLESS Randomized Controlled Trial. PEERLESS was a trial that enrolled patients with intermediate-risk (sub-massive) PE and randomised them to either large-bore mechanical thrombectomy or catheter directed thrombolysis. The headline finding from PEERLESS is that mechanical thrombectomy is superior to catheter directed thrombolysis but as ever, if you read beyond the abstract, you will find that it is much more complex than that. The study used an interesting primary endpoint called "win ratio" and the show includes a detailed explanation and analysis of what this is, its benefits, and its drawbacks.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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AI powered ultrasound for DVT - an interview with CEO of ThinkSono, Fouad Al Noor

Fri, 21 Mar 2025 10:04:20 GMT

On this episode, Pip and Rich chat to Fouad Al Noor, CEO of ThinkSono. ThinkSono have developed an AI-powered handheld scanning tool for DVT that enables anyone to perform a diagnostic quality ultrasound scan for the diagnosis of DVT. The images are then reviewed by a radiologist, providing a rapid answer for most patients. The tool is entering use within the NHS and in this podcast, Pip and Rich discuss the story and the evidence behind ThinkSono as well as the challenges and opportunities that the tool provides.

For more information, visit www.thinksono.com and to access the evidence, head to www.thinksono.com/research.

Pip and Rich have no relevant conflicts of interest for this episode. The podcast was initially started thanks to a hands off grant from Sobi who have had no editorial input into the show.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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Iptacopan for PNH

Fri, 07 Mar 2025 09:54:33 GMT

In this episode, Rich and Pip discuss de Latour et al. Oral Iptacopan Monotherapy in Paroxysmal Nocturnal Hemoglobinuria. NEJM 2024. Iptacopan is a proximal complement inhibitor and the first oral treatment for paroxysmal nocturnal haemoglobinuria.

The study randomised patients to either continuation of a C5 inhibitor or switch to ictacopan and found that a significant proportion of patients achieved hemoglobin levels of 120 g/L or higher without the need for transfusions. The treatment was generally well-tolerated, with a safety profile consistent with previous studies, suggesting that iptacopan is a viable alternative to existing therapies.

Join us as we delve into the study's methodology, results, and implications for the future management of PNH.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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Plasma exchange free treatment of TTP: Author Discussion

Fri, 21 Feb 2025 17:17:14 GMT

In this episode, Pip and Rich discuss plasma exchange free treatment of thrombotic thrombocytopenic purpura with Dr Lucas Kuhne and Professor Paul Brinkoetter, authors of a recent study in Blood: Kühne et al. Management of immune thrombotic thrombocytopenic purpura without therapeutic plasma exchange.

The study is an observational, retrospective study reporting outcomes of patients with TTP who were treated without plasma exchange, which is currently considered the standard of care. The advent of a novel nanobody against vWF called caplacizumab, that targets and prevents catastrophic thrombosis that is seen in TTP, has allowed the study of this approach.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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Plasma exchange free treatment of TTP

Fri, 31 Jan 2025 12:33:11 GMT

In this episode, Rich and Pip discuss a paper a German/Austrian study published in Blood: Kühne et al. Management of immune thrombotic thrombocytopenic purpura without therapeutic plasma exchange.

In a follow-up episode, Rich and Pip will interview the study authors.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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Exa-cel for severe sickle cell disease

Tue, 12 Nov 2024 20:47:25 GMT

In this episode, Rich and Pip discuss gene therapy for sickle cell disease, focusing on Frangoul et al. Exagamglogene Autotemcel for Severe Sickle Cell Disease, NEJM 2024.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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ANNEXA-I: Discussion with Dr Will Lester

Wed, 02 Oct 2024 12:33:22 GMT

In this episode, Pip and Rich discuss ANNEXA-I with Dr Will Lester, consultant haematologist at University Hospitals Birmingham. ANNEXA-I was a randomised controlled trial of andexanet alfa for reversal of anti-FXa oral anticoagulants in patients with intracerebral haemorrhage. There's a lot to get your teeth stuck into so and this one is a lively discussion!

Disclosure: Pip and Rich are named investigators on a grant from AstraZeneca to audit the use of reversal agents (including andexanet) across the UK. Pip has also received honoraria from AstraZeneca. Will has received honoraria from AstraZeneca. To see our full list of financial disclosures, search for us on Who Pays This Doctor.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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ANNEXA-I

Thu, 22 Aug 2024 14:47:51 GMT

In this episode, Rich and Pip discuss the ANNEXA-I trial (https://www.nejm.org/doi/full/10.1056/NEJMoa2313040). This was a randomised controlled trial of andexanet alfa, a decoy factor Xa molecule that is a reversal agent for oral factor Xa inhibitors. Patients were randomised to andexanet alfa or usual care. The primary outcome was haemostatic efficacy and andexanet alfa was shown to result in better control of haematoma expansion compared to usual care. However, there are many discussion points here not least the validity of the surrogate outcomes used in the trial.

Disclosure: Pip and Rich are named investigators on a grant from AstraZeneca to audit the use of reversal agents (including andexanet) across the UK. Pip has also received honoraria from AstraZeneca. To see our full list of financial disclosures, search for us on Who Pays This Doctor.

In the next episode, Pip and Rich will discuss ANNEXA-I with Dr Will Lester.

There is also a tiny mistake in the news section where Pip says that the infected blood inquiry report is 1200 pages long where in fact it is over 2500.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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VITT, HIT, and spontaneous syndromes

Sun, 26 May 2024 21:13:26 GMT

In this episode, Rich and Pip discuss vaccine-induced immune thrombotic thrombocytopenia and heparin-induced thrombocytopenia. They critique a recent paper that has shown that VITT has been around before vaccines against Covid-19. Importantly, they discuss which patients should be tested for spontaneous VITT- and HIT-like syndromes, and discuss a recent case.

The paper is: Schönborn L. et al. Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure. Blood. 2023 Dec 28;142(26):2305-2314.

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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Efgartigimod for ITP

Tue, 16 Apr 2024 20:45:09 GMT

In this episode, Pip and Rich discuss the ADVANCE IV trial: Efficacy and safety of the neonatal Fc receptor inhibitor efgartigimod in adults with primary immune thrombocytopenia: a multicentre, randomised, placebo-controlled, phase 3 trial.

With the help of Professor of Immunohaematology, Prof. Nikki Cooper, Rich and Pip dissect the trial, learning loads about ITP and the difficulties of doing trials in this space.

Links

Broome C et al. Efficacy and safety of the neonatal Fc receptor inhibitor efgartigimod in adults with primary immune thrombocytopenia (ADVANCE IV): a multicentre, randomised, placebo-controlled, phase 3 trial. Lancet. 2023 Nov 4;402(10413):1648-1659

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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FRAIL-AF

Mon, 04 Mar 2024 16:38:42 GMT

In this episode, Pip and Rich discuss the FRAIL-AF study: Joosten et al. Safety of Switching From a Vitamin K Antagonist to a Non–Vitamin K Antagonist Oral Anticoagulant in Frail Older Patients With Atrial Fibrillation: Results of the FRAIL-AF Randomized Controlled Trial. Circulation. 2024;149:279–289.

This trial randomised the switching of elderly frail patients who were established on a vitamin K antagonist to either remain on this treatment or switch to a direct oral anticoagulant. They found increased rates of bleeding in the switch arm. However, there is a lot of detail that is not in the abstract! Pip and Rich take a deep dive into the manuscript, discuss their thoughts with Chief Investigator, Geert Jan Geersing on the trial, and put the findings into context with consultant haematologist David Sutton.

To read more about this trial check out Rich's blog on it: https://classicalcompass.substack.com/p/frail-af

Links

FRAIL-AF: https://www.ahajournals.org/doi/epdf/10.1161/CIRCULATIONAHA.123.066485

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The PACER trial

Sun, 21 Jan 2024 18:19:20 GMT

In this, the first episode Drs Pip Nicolson and Rich Buka take a deep dive into the PACER trial: Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. After a quick round up of other trials that have sparked their interest, Pip and Rich discuss about the study aims and outcomes, before interviewing Dr Floor van Baarle, lead study author before discussing the clinical implications of the trial with Prof Simon Stanworth.

Follow Pip, Rich, and HaemSTAR on X/Twitter: @PipNicolson, @RichardBuka, and @HaemSTAR_UK

To claim CPD credits, please email haemstarnetwork@gmail.com.

Links

This episode was sponsored by Sobi as a hands-off educational grant. Sobi had no editorial input whatsoever.

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