What's Hot in Clots: December 2025

I have to admit, the fall—especially its final stretch—is not my favorite time of year. What makes it much better, though, are the many celebrations across faiths and cultures, and Thanksgiving is one of my absolute favorites! For those of you who celebrate, I hope you had a wonderful holiday. I’m grateful for the chance to share these thoughts with you—and for the wealth of important clot-related papers published over the past month!

Global burden of venous thromboembolism: Forgotten no more!

Many scholarly groups, including the Global Burden of Disease collaborative have made incredible contributions to help us understand the global burden of coronary disease, myocardial infarction, stroke, heart failure, and many other cardiovascular conditions. However, venous thromboembolism (VTE) has been systematically left out; in many reports being dumped because of “garbage codes.” Well, forgotten no more! We have made it a top priority, here summarizing the gaps and also sharing a path forward. If interested in collaborating or supporting the initiative, feel free to reach out to me. Read more.

Antithrombotic therapy for stable ASCVD and AF: Is it news anymore that less is more?

Many studies were already covered by the VLN team, and goodness, AHA had some many cool papers!

We have shared in a couple of prior blogs that anticoagulant monotherapy resulted in fewer bleeding events. Now, I want to share two studies from AHA 2025. The first one, published in NEJM, showed—once again—that anticoagulant monotherapy, compared with anticoagulation + single-agent antiplatelet therapy (SAPT), will not lead to an increase in ischemic events but reduces bleeding.

The one that I found more provocative, though, is OPTIMA-AF (not published yet to my knowledge). There, the authors suggested fewer bleeding events in those receiving anticoagulant monotherapy instead of anticoagulation plus SAPT, only one month after PCI. Although this is very interesting, I take it with caution given the numeric increase in ischemic events and the fact that the study was not powered for ischemic events. I look forward to reading the full paper when published. Read more.

Beta blockers post-MI: What do we do?

This paper has a few interesting points. The first is that NEJM rarely publishes meta-analyses, even if it’s an Individual Participant Data Meta-Analysis—but this is one! Second, it focuses on patients post-MI with left ventricular ejection fraction (LVEF) >50% who did not have another indication for beta-blockers. In other words, the findings should not be extrapolated to those who have depressed LVEF or an indication for beta-blockers. Third and finally, in this context, they found no benefit to beta-blocker therapy. I find this both practice-informing and in many centers, practice-changing! Read more.

Large language models and thrombosis education

In this thought-provoking study, LLMs did a good job sharing educational information for VTE. Is there room to go? I’d argue yes. And from personal anecdotes, I can share that they still get many things wrong without being prompted—but still huge improvements! Read more.

Factor XI/ XIa inhibitors: The saga continues

A few years ago, inhibition of factor XI was fresh blood in investigations for prevention or treatment of thrombosis with the premise of not increasing the bleeding risk. But then, the results of many studies turned out to be underwhelming; there were neutral results compared with placebo/no treatment, or less effectiveness compared with traditional anticoagulants. I had shared a cautionary summary before that while these agents seemed largely safe, it remained to be seen if they were efficacious. Now, more fuel was put on the fire this month. First, two more phase II trials came out for preventing postoperative VTE. Then, it was announced that the LIBREXIA ACS trial was halted prematurely for futility. Finally, we heard that OCEANIC-STROKE suggested superiority for asundexian as add-on to antiplatelet therapy without causing excess major bleeds. Neither of the latter two studies have been formally presented or published, yet. Read more here and here.

Behnood Bikdeli, MD, MS