Want to stay up-to-date on the very latest developments in medical haematology? Don't have the time or skills to critically appraise important papers? Join Pip and Rich, two haematology doctors on a journey of learning and discovery. They will discuss seminal trials, critically appraising papers and interview authors and subject experts.
This podcast helps you to go beyond the abstract, delving deep into the methods, results, sub-analyses, and implications. Interviews with authors gives a real-life perspective on the running of a clinical trial allowing explanations of why they did what they did and good honest discussion on limitations and how they might do it differently next time.
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On this episode, Pip and Rich talk to Dr Noma Tshuma, a haematology registrar and Clinical Research Fellow + PhD student at the University of Cambridge. During her time as an AI fellow at University College London Hospitals, Noma developed the Data Clinic, a structure through which clinical research using real world evidence could be performed using technology with a fraction of the effort needed for manual data extraction. We discuss the practicalities of the project as well as speculating about the future. A must listen for anyone interested clinical evidence.
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8 Sept 2026
HI-PEITHO: Does catheter-directed fibrinolysis improve outcomes in intermediate-risk PE?
On this episode, Pip and Rich discuss HI-PEITHO (https://www.nejm.org/doi/full/10.1056/NEJMoa2516567), 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!
This episode was sponsored by Novo Nordisk who provided a hands-off educational grant to HaemSTAR. Novo Nordisk had no editorial input whatsoever.
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2 Aug 2026
C-TRACT: does venous stenting make a difference in post-thrombotic syndrome?
In this episode, Pip and Rich discuss the C-TRACT trial: Vedantham et al. Endovascular Therapy for Post-Thrombotic Syndrome — A Randomized Trial. 2026 (https://www.nejm.org/doi/full/10.1056/NEJMoa2519001)
N Engl J Med 2026;394:2293-2304 (https://www.nejm.org/doi/full/10.1056/NEJMoa2519001)
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.
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Pip host the show. Published by Richard Buka.
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