What’s Hot in Clots – November 2023

Key Updates in Thrombosis

Table of Contents

1. Extracts from Scorpion, Centipede, and Leech to the Rescue for Patients with STEMI!
2. ANNEXA-I trial: Success? Failure? Or It Is Complicated?
3. Stopping Aspirin Early After PCI for Acute Coronary Syndromes: Less is More?
4. Statin Therapy for Critically Ill Patients with COVID-19
5. Treatment of Lower Extremity PAD: More Data Means Informed Choices for Patients and Clinicians

Extracts from Scorpion, Centipede, and Leech to the Rescue for Patients with STEMI!

I did not find an old wizard scroll in a remote basement. The pick for Halloween? Maybe. This comes from JAMA this week! Among 3777 patients included in the primary analysis, Tongxinluo (a traditional Chinese medicine that includes extracts from plants, and scorpion, centipede, and leech) was associated with significant reductions in cardiovascular events and cardiac death! Dr. Curfman, Deputy Editor of JAMA, shared a cautionary note, highlighting that the mechanism for such a marked improvement in outcomes is yet unknown. Either it is a spurious finding, or that the discovery of the mechanism may lead to a Nobel Prize! Read more.

ANNEXA-I trial: Success? Failure? Or It Is Complicated?

Results of the ANNEXA-I trial were recently presented. Interim analyses of 450 patients randomized to andexanet alfa vs usual care in patients receiving apixaban or rivaroxaban and experiencing an intracranial hemorrhage suggested superior hemostatic efficacy, leading the Data and Safety Monitoring Board to recommend stopping the trial. The results have been met with lots of enthusiasm from the trialists and the manufacturer, but also skepticism from some investigators that I have communicated with. Where does the truth lie? Maybe in between. I would love to see the peer-reviewed final publication to understand the details better. Read more.

Stopping Aspirin Early After PCI for Acute Coronary Syndromes: Less is More?

Results from a multicenter open-label non-inferiority trial for patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and receiving P2Y12 inhibition with ticagrelor suggest that abbreviated dual antiplatelet therapy (DAPT – less than 1 month) was both non-inferior and also superior for the primary outcome of net benefit, defined as a composite of all-cause death, myocardial infarction, definite or probable stent thrombosis, stroke, and major bleeding at 1 year after the index procedure. There was no significant increase in ischemic events, although there was a significant reduction in bleeding, including major bleeding with abbreviated DAPT. I would still be cautious with higher-risk patients such as those with STEMI in the setting of diabetes. However, the results are really thought-provoking and complement what we learned from trials such as TWILIGHT. Read more.

Statin Therapy for Critically Ill Patients with COVID-19

Similar to a previously reported trial, recent findings from REMAP-CAP did not show superiority of statin therapy vs standard treatment for critically ill patients with COVID-19. But similar to the prior trial, there were hints of improved outcome. Would a pooled analysis show benefit and find an inexpensive alternative therapy for COVID-19? Time will tell. Read more.

Treatment of Lower Extremity PAD: More Data Means Informed Choices for Patients and Clinicians

Results from the LIFE-BTK trial were presented during TCT 2023 and simultaneously published. The study, despite its relatively small size, suggests that for intrahospital PAD associated with limb-threatening ischemia, an everolimus-eluting resorbable scaffold may be superior to conventional angioplasty in reducing amputations, target vessel occlusion or restenosis, or repeat revascularization. I find these results, paired with BASIL-2 and BEST-CLI, as important steps forward to help patients and clinicians with informed decision-making. Read more.

Lastly, I do not consider myself particularly political or even knowledgeable about it – but as someone in the community of healers, I hope and pray for a better world with less suffering and violence, one where dialogue and respect prevail.

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