What's Hot in Clots | September 2025

My goodness, this month there was so much going on that it would have been a lot easier for me to write on what’s not hot in clots!

Extended-duration anticoagulation after provoked VTE in patients with enduring risk factors

Many people thought and practiced as if provoked VTE meant that patients needed only short-term anticoagulation. The reality of clinical practice, however, has been more nuanced as acknowledged by some guidelines.

We sometimes face patients with VTE that had a major provoking factor but also one or several enduring risk factors (such as inflammatory diseases, cardiopulmonary disease, etc).

The HI-PRO addressed the tradeoffs of extended-duration anticoagulation in those patients. Briefly, low-intensity apixaban was superior to placebo for extended-duration treatment, with marked relative risk reduction for recurrent VTE and no increase in major bleeding.  Read more.

Would aspirin have added benefit in stable patients who receive anticoagulation?

We discussed previously (here and here) that in a pooled analysis of clinical trials from East Asia, among stable patients with CAD and AF, aspirin as an add-on to anticoagulation did not confer ischemic benefit and was associated with excess bleeding. Similar results are now shown in the AQUATIC trial from France. Read more.

Clots and the court: Venous thromboembolism-related litigation after orthopedic surgery

A research article provides a systematic assessment of some of these malpractice cases involving patients with. VTE. Briefly, key themes included delays in diagnosis and treatment, and improper use of VTE prophylaxis.

In the Editorial, we discussed how appropriate care should be considered without moving toward “defensive medicine.” Read more here and here.

H-pylori screening not beneficial to all-comers with acute MI

What? Are you now “what’s hot in general internal medicine”? Ummm, I love medicine, but have and will keep my fidelity to WHIC! The thought here was that H-pylori may be related to an excess risk of GI ulcers and GI bleeding therefore, screening could improve outcomes.

Well, the study didn’t quite prove that, although there are signals for higher-risk individuals (with anemia) that may be explored further in future. Read more.

Is it okay to stop anticoagulation after successful catheter ablation for AF?

The guidelines have largely encouraged continuation of anticoagulation (if there is an indication) irrespective of success with AF ablation. Now, a randomized trial is challenging that conventional wisdom, showing fewer strokes during follow-up and more bleeds with anticoagulation…

Not so fast, though. I am still cautious. This was a relatively small trial, the follow-up was for a maximum of 2 years (not all patients achieving that), and those who had recurrence of AF in the control arm were allowed to receive anticoagulation.

So, to me, it’s interesting data—especially for those who insist on stopping anticoagulation, but not entirely game-changing…yet. Read more here and here.

Twice-daily clopidogrel vs ticagrelor in STEMI

The traditional dosing of clopidogrel (unlike ticagrelor) is once daily. The thinking is that clopidogrel is an irreversible P2Y12 inhibitor. However, the investigators thought that twice-daily dosing might provide more consistent platelet inhibition and did a single center double-blind randomized trial in patients with STEMI.

The study was underpowered and inconclusive. Still, the findings are interesting and will generate further discussion, especially in low-resource settings. Read more here and here.