What’s Hot in Clots – July 2023

Key Updates in Thrombosis

Table of Contents

1. Routine VTE prophylaxis in hospitalized medical patients: Is it really needed?
2. COVID-19 and blood clots? Again? Really? Why should I care?
3. The AIR trial results at ISTH 2023
4. The ARAMIS Randomized Clinical Trial

There is a lot to discuss this month! I just returned from my first in-person experience at the International Society of Thrombosis and Haemostasis (ISTH) 2023 Congress, visiting friends and mentors that I had not met before and enjoying the beautiful city of Montreal and tasty dishes! AirCanada was the only downside – cancelling my flights on both ends and being unhelpful even for leaving the airport – but the meeting was nothing short of amazing and included wonderful lectures, educational sessions, networking opportunities, and even the Dragon’s Den! Here’s my summary for this month:

Routine VTE prophylaxis in hospitalized medical patients: Is it really needed?

Based on data from older trials, VTE prophylaxis is the norm in hospitalized medical patients, with many health systems incorporating electronic alerts into their electronic medical records. And yet, French investigators have challenged this idea among older adults. The point estimates are suggestive and the study was underpowered. All this said, the event rates were low, questioning a large treatment effect. Read more

COVID-19 and blood clots? Again? Really? Why should I care?

The pandemic is over, but the virus continues to exist, causing periodic outbreaks in the endemic form and is likely here to stay with us – which makes it important to continue to learn about its epidemiology and how to prevent the cardiovascular complications. Some noteworthy studies:

• The CORONA-VTE Network registry will provide additional knowledge from >10,000 patients with PCR-confirmed COVID-19 about adjudicated cardiovascular and thrombotic events and will include key subgroups such as pregnant women, older adults, and those with cancer. Read more
• The COVI-DOSE trial failed to show a benefit from intermediate-dose anticoagulation (compared with standard-dose prophylactic anticoagulation) in 1,000 hospitalized patients, of whom 80% were not critically ill. Read more
• Crizanlizumab (a P-selectin inhibitor), compared with usual care, did not improve organ-support-free days and was associated with a numeric increase in mortality. Read more

The AIR trial results at ISTH 2023

As we discussed previously, the AIR trial was a pilot randomized trial of oxygen therapy vs control in patients with intermediate-risk pulmonary embolism without hypoxemia. At ISTH 2023, Dr. Jimenez presented the key findings. Here is a video interview. The design paper can be seen here. Oxygen is inexpensive and widely available. Is it time for a definitive clinical outcomes trial?

The ARAMIS Randomized Clinical Trial

Can dual antiplatelet therapy (DAPT) work just fine in patients with minor nondisabling acute ischemic stroke?

Reperfusion, commonly with fibrinolytic therapy, is the standard treatment in patients with acute ischemic stroke. In a large randomized trial, the investigators showed that DAPT was non-inferior to fibrinolysis with alteplase. Read more.

Enjoy this update? Be sure to subscribe to get the latest updates each month.

---