What's Hot in Clots: August 2026
Aug 1, 2026
Behnood Bikdeli, MD, MS
Vascular Medicine Advisor, VLN Medical Advisory Board
When I was a child, I very much cherished the summer holidays. Well, these days, there are not many holidays for me, but I still enjoy the summer. For those of you who like the warmer weather, I hope you feel the same. My heart goes out to those who are facing challenges with the recent wildfires.
De-prescribing aspirin: What’s the state of the art?
I’ve covered plenty of “less is more” articles in this blog within the past couple of years. This State of the Art review is very timely in summarizing the data about aspirin withdrawal, when it’s reasonable, and how to consider it. Read more.
Not all ischemic strokes are created equally
For those of you who have followed this blog for a while, you know that I’m no translational scientist. And yet, I found this study very interesting. It suggests different hemostatic profiles for patients with ischemic stroke without AF, or based on the timing of AF. This didn’t test everything but I agree with the concepts wholeheartedly. We practice in simplistic ways, and use tools such as CHA2DS2VASc (ummm, some dropping the sex category from it). I hope in a few years that we’re able to profile patients in a more detailed way and offer therapies with greater precision. When do I expect a major change? Maybe in 7 years—not sooner.
DAPT MVD: More is more!
Who was it that was discussing de-prescription strategies? Oops, that was me! But wait a minute, this new randomized trial showed that among patients with stable multivessel coronary disease, clopidogrel-based DAPT was superior to aspirin monotherapy for a composite effectiveness outcome, although all-cause and cardiovascular death were comparable in the two groups.
OPTIMA-AF: Less is more!
As if I didn’t confuse you enough already, let’s end with another less-is-more trial! OPTIMA-AF showed that in patients with AF undergoing PCI with intravascular imaging guidance, 1-month dual antithrombotic therapy (direct DOAC plus P2Y12 inhibitor) followed by DOAC monotherapy has noninferior effectiveness and superior safety (major or clinically relevant nonmajor bleeding) compared with 12-month dual therapy followed by DOAC monotherapy. Read more.