What’s Hot in Clots – January 2025

Key Updates in Thrombosis

Table of Contents

1. Ticagrelor in patients with acute myocardial infarction
2. Management of severe bleeding in patients receiving oral anticoagulants
3. The most updated and comprehensive review on anticoagulation in COVID-19
4. When to use and when to avoid DOACs
5. Low-dose aspirin in patients with seropositivity for antiphospholipid antibodies?
6. Flash mob to the rescue for understanding deprescription patterns of anticoagulants in patients with cancer!

Let me start by sharing with you how fortunate I have felt by receiving messages from many of you who read these summaries and have shared interest, comments, and critiques. My gratitude also goes to the Vasculearn Network (VLN) team who have supported me in continuing this monthly update. And I wish you all the very best in 2025!

Ticagrelor in patients with acute myocardial infarction

There is little doubt that ticagrelor, which does not depend on activation by CYP2C19, is a more potent P2Y12 inhibitor than clopidogrel. However, there was concern—going back to several years ago—about the interaction by region in the results of the landmark PLATO trial with less favorable findings noted in the United States. Now, an investigative report in the BMJ casts further doubts about the magnitude of reported effects in PLATO, including the deaths with ticagrelor vs clopidogrel, which have received attention in part because some other studies have failed to replicate the magnitude of benefit observed in PLATO. Read more.

Management of severe bleeding in patients receiving oral anticoagulants

This comprehensive review paper covers what you need to know for the management of bleeding events in patients receiving oral anticoagulants. It includes illustrative tables and diagrams about how to assess the risk, drug levels, and reversal agents, among other resources. Read more.

The most updated and comprehensive review on anticoagulation in COVID-19

This work by the WHO investigators and PIs of several trials is the most comprehensive that I have seen. In full disclosure, I have been a (small) part of it, too, but have a hard time encapsulating it for clinical practice given the complexities that were presented in the analytics of this paper. I would still think of low-intensity heparin for critically ill patients, and higher doses for carefully selected hospitalized patients who are not critically ill. Read more.

When to use and when to avoid DOACs

Now, I’m not in the habit of sharing old(er) papers in a blog that is meant to cover news. So, what’s the catch? The reason I’m sharing this review article again is that it ranked #1 for reviews and downloads among all publications in JACC in 2024! Trust me, it is the to-go paper if you want to read about DOACs! Read more, and here is a slightly updated and trimmed version. 

Low-dose aspirin in patients with seropositivity for antiphospholipid antibodies?

Thrombotic antiphospholipid syndrome is one of the most challenging thrombotic conditions with a high risk of subsequent venous and arterial thrombosis. Another question is what to do for people who have seropositivity for antiphospholipid antibodies but do not strictly meet research criteria for thrombotic antiphospholipid syndrome. This pooled analysis generates hypotheses that perhaps low-dose aspirin can be a consideration in such patients. Read more.

Flash mob to the rescue for understanding deprescription patterns of anticoagulants in patients with cancer!

There’s a first time for everything, including “uneducated me” learning that a flash mob is also a research method for conducting surveys! Using this methodology, the authors learned about patterns of considering, as well as actually committing to, deprescription of anticoagulants in patients with cancer who are close to end of life. Read more.

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