What's Hot in Clots: August 2025

By Behnood Bikdeli, MD, MS
Vascular Medicine Advisor, VLN Medical Advisory Board

To thin or not to thin the blood after intracranial bleed and AF? That’s the question.

It’s such a challenging situation for patients and clinicians alike to find a path forward after an intracranial bleed in patients with atrial fibrillation (AF). Do we stop anticoagulants for good? Do we restart them after a while? There have been a few randomized controlled trials—but none were definitive in isolation, which makes this ewly published systematic review and meta-analysis very timely.

Briefly, there was a reduction in ischemic stroke and net adverse clinical events, although this finding was accompanied by an increase in recurrent intracranial bleeding.

PFO and stroke: Here’s what you need to know

Nearly one in every four individuals have a patent foramen ovale (PFO), which translates to nearly one in every two of these patients having an embolic stroke of unclear source (cryptogenic stroke) above the age of 60. This JAMA review article summarizes the approach for risk stratification and management.

Patient perspectives on antithrombotic therapy in the setting of advanced cancer

Although I don’t often cover qualitative studies, this one is pretty interesting. And if my endorsement isn’t enough, see what the authors placed as the first part of their title–true story: “Who am I to say that I'm not going to take it…”. There are important lessons to learn here for clinicians, investigators, and patients.

Edoxaban vs warfarin for the early period after bioprosthetic mitral or aortic valve replacement

This randomized trial tested edoxaban vs the historical reference (warfarin) for the early period after replacement with a tissue valve. The bigger question in my mind is whether most of these patients in current practice need anticoagulation at all...