What’s Hot in Clots – December 2024

Key Updates in Thrombosis

Table of Contents

1. Randomized trial results helping shape the evidence base for PE care: The case of the PEERLESS trial
2. How should antiplatelet or anticoagulant agents be adjusted prior to dental procedures? We got you covered!
3. What’s hot in the world of IVC filters?
4. Factor XI inhibitors: Should we be concerned about off-target effects?
5. For how long should we treat cancer-associated PE?
6. PE research with electronic databases: Are we all set with validated tools?

As I wrap up this summary over the Thanksgiving weekend, there are many things I find myself thankful for; great family, friends, colleagues, collaborators, and patients who inspire me to do more and do better. And I am thankful for the opportunity to have collaborated with NATF…wait a minute, it is now Vasculearn Network (VLN)! Thankfully, they allowed me to keep this blog unchanged. So, here we go with clot updates, and we have plenty!

Randomized trial results helping shape the evidence base for PE care: The case of the PEERLESS trial

At TCT, the PEERLESS investigators reported their trial results of large bore catheter-directed thrombectomy or catheter-directed fibrinolysis. Briefly, major bleeding and PE-related death were both uncommon. There were no significant differences between the two groups in the rates of death, intracranial bleeding, or major bleeding. The main question to me is if—and which patients with intermediate-risk PE—need procedures at all, above and beyond anticoagulation. Some other ongoing trials will be informative. Read more

How should antiplatelet or anticoagulant agents be adjusted prior to dental procedures? We got you covered!

This comprehensive review paper discusses the hemorrhagic risk from various dental procedures and the risk of thrombotic events from cessation of antithrombotic therapy. We provide recommendations to minimize bleeding, considerations for local hemostatic measures, and practical algorithms for continuing vs holding antithrombotic agents considering hemorrhagic vs thrombotic risk. Read more.

What’s hot in the world of IVC filters?

There are two studies that I want to highlight. First is a collaborative effort between academic investigators and the Food and Drug Administration (FDA) that sheds light on the safety of IVC filters in US older adults. Most strikingly, the study showed that there was a decline in use of IVC filters over time. However, only 15% of these devices had a retrieval attempt! In an accompanying editorial, we discussed the opportunities to improve post-marketing surveillance of medical devices, including IVC filters. Read the paper here and the editorial here.

A second study that I’d like to highlight is also about the safety of these devices – and some signals that were made available to the public only after court documents were unsealed to allow communication in scientific publications and opportunities to improve information disclosure, regulatory testing, and communication about safety of medical devices. Read more.

Factor XI inhibitors: Should we be concerned about off-target effects?

The initial results from trials of factor XI inhibitors have been quite mixed, and some have been surprising or disappointing. Now, a study from the Atherosclerosis Risk in Communities (ARIC) cohort raises concern for excess risk of incident heart failure in patients with decreased XI levels. Would this be of clinical relevance in clinical trials of factor XI or XIa inhibitors? Time will tell. I will keep an eye out for investigators to report such outcomes in ongoing trials. Read more.

For how long should we treat cancer-associated PE?

Let’s keep this one short and sweet. In patients with low-risk cancer-associated PE, more is more! An 18-month duration of anticoagulation, compared with 6 months of therapy, led to fewer recurrent VTE events (odds ratio: 0.25). Read more.

PE research with electronic databases: Are we all set with validated tools?

I wouldn’t be boring you with this if the answer was yes. Alas, many prior studies used International Classification of Disease (ICD) codes with limited validations to report on PE epidemiology or to run comparative effectiveness analyses. In this AHA-awarded project, we validated algorithms using ICD-10 codes to efficiently identify PE using these codes. Ongoing work will also validate tools for natural language processing in electronic health record data that have access to radiology reports. Read more.

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