What’s Hot in Clots – January 2023

Key Updates in Thrombosis

Table of Contents

1. “How Did We Get Here?” More questions than answers for antithrombotic therapy in patients with aortic bioprosthesis
2. ASCOT trial in COVID-19: Yet another failure for intermediate-dose anticoagulation
3. LMWHs do not improve the rate of live births in pregnant women with recurrent pregnancy loss and inherited thrombophilia
4. Duration of anticoagulation in isolated distal DVT: The RIDTS trial

“How Did We Get Here?” More questions than answers for antithrombotic therapy in patients with aortic bioprosthesis

Surface-related factors, procedure-related factors, and hemodynamic factors predispose patients with bioprosthetic aortic valves to increased risk of leaflet thrombosis, which can subsequently lead to local as well as systemic (embolic) complications. In a review of the literature, the authors highlight the existing knowledge and major gaps in data to guide management of patients with surgical or transcatheter aortic bioprosthesis. Learn more!

ASCOT trial in COVID-19: Yet another failure for intermediate-dose anticoagulation

Results of the Australasian Covid-19 Trial (ASCOT) were recently published. Patients were randomized to low-intensity low-molecular-weight heparin (LMWH) monotherapy, low-intensity LMWH plus aspirin, intermediate-dose LMWH, and, in response to data from other trials later in the conduct of the trial, a full-intensity LMWH arm. The trial recruited patients from February 2021 until April 2022, and 1526 participants (mostly from India) were included in the final analysis. Similar to INSPIRATION, an earlier trial of ICU patients with COVID-19 that I was a part of, ASCOT did not show any benefit from intermediate-dose anticoagulation, compared with standard-dose prophylaxis. Interestingly, thrombotic events were rare in all arms of ASCOT. Is it related to the differences in viral variants? Or are we getting better at suppressing thromboinflammation with antiviral and anti-inflammatory therapies? The ongoing meta-analyses need to consider the time of enrollment as an important covariate for their analyses. Learn more!

LMWHs do not improve the rate of live births in pregnant women with recurrent pregnancy loss and inherited thrombophilia

Results of ALIFE2 trial were recently presented at the American Society of Hematology annual meeting. The study showed that pregnant women with history of ≥2 pregnancy losses and inherited thrombophilia (factor V Leiden, prothrombin 20210A mutation, antithrombin, protein C or protein S deficiency) did not benefit from being randomized to low-intensity LMWH therapy, compared with usual care. There was no significant improvement in the rate of live births (71.6% vs 70.9%). Peer-reviewed full trial results are yet to be published. Learn more!

Duration of anticoagulation in isolated distal DVT: The RIDTS trial

Let’s end on a positive note: A randomized trial of patients with symptomatic distal deep vein thrombosis, despite premature termination, showed that 3 months of anticoagulation with rivaroxaban is superior to 6 weeks of anticoagulation with respect to the rate of recurrent venous thrombosis. Interestingly, no major bleeding events were identified. The majority of recurrent events were in the form of symptomatic distal DVTs. Learn more!

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