What's Hot in Clots: July 2026

For those in the US Northeast, there’s recently been big news about the Knicks, and many others—myself included—are anxiously tracking the World Cup games. For those with no interest in sports, I hope that you’re at least enjoying the warmer weather and finding some time to recharge the batteries! Here are this month’s summaries:

Menaquinone-7 and coronary calcification: Warfarin rising from the ashes?

Let me start by restating that I’m really a proponent of clinically important outcomes and not surrogates. And yet, this study of menaquinone-7 was very provocative in potentially reducing coronary calcification. Would there be a redemption for warfarin with verification in outcomes trials? Read more.

Very-low-dose rivaroxaban in patients with advanced kidney disease or ESRD: One step, and then two more steps off TRACK!

Very-low-dose rivaroxaban (2.5 mg twice daily) is a regimen that I personally use not infrequently in stable patients with atherosclerotic cardiovascular disease, paired with aspirin, to reduce the risk of vascular events (based on trials such as COMPASS and VOYAGER). We also know that patients with advanced kidney disease have a high risk for both vascular events and bleeding. In the TRACK randomized trial, patients with advanced kidney disease or those who were dialysis-dependent were randomized to rivaroxaban 2.5 mg bid or placebo. The results were an utter failure. There was no improvement in the primary effectiveness outcome, a composite of cardiovascular death, nonfatal myocardial infarction, stroke, or a peripheral artery disease event. And worse, bleeding events significantly increased. The subgroup analysis results, including concomitant use of aspirin or not (among others) were similarly hopeless. The discussion was academic but didn’t offer anything that shows a better-looking horizon in future. Biology is complicated—but we really need to help people with advanced kidney disease! Read more.

Anticoagulation reversal review

Are you looking for a high-quality review on anticoagulation reversal? Your wish, my command! This NEJM review is fairly succinct—but pragmatic and useful. Read more.

Catheter-associated thrombosis: Do we know enough?

I love DOACs in most cases but am personally skeptical of them in catheter-associated thrombosis, using them only cautiously and not widely (see this). Unlike DOACs, which selectively inhibit a single coagulation factor, low-molecular-weight heparins, such as enoxaparin, exert a broader anticoagulant effect by potentiating antithrombin-mediated inhibition of multiple targets, predominantly factor Xa but also factor IIa and other serine proteases in the coagulation cascade. The situation is even more complicated in cancer-associated, catheter-related thrombosis. The investigators reported findings from their 2-year results and the accompanying editorial put the findings in context and shared hope about potential future improvements with XI/XIa inhibitors. Read more here and here.