What's Hot in Clots: June 2026
Jun 1, 2026
Behnood Bikdeli, MD, MS
Vascular Medicine Advisor, VLN Medical Advisory Board
Not planning to start all WHIC issues with obituaries, but have to write about the late Richard Lehman, who passed away recently. I am not even remotely close to his cunning, witty, smart writing style but should share that his many years of writing a blog for the BMJ was an inspiration for me.
Venous thromboembolism in athletes: One death is too many
A recent study reported on fatal PE among NCAA athletes. Although small in numbers, these are young athletic individuals—one death is too many! In the accompanying editorial, we also reflect on the broader issue of VTE among athletes, which also includes upper extremity DVT, lower extremity DVT, and cerebral vein sinus thrombosis.
Is it LDL? Or coincidentally we have several lucky winners? The case of LDL-lowering therapies and VTE
JUPITER opened a new frontier with its finding that statins may reduce the risk of incident VTE. This trial was followed by a pooled analysis with HOPE-3. And then, results from some PCSK9 inhibitor trials shared similar findings. It’s in this context that I found a post-hoc analysis of the CLEAR Outcomes trial very fascinating, showing a ~40% risk reduction in VTE events with bempedoic acid. This doesn’t align with all Mendelian randomization studies that we know of, but brings a major question to my mind. Do we simply have many lucky winners? Or is LDL really causally implicated for VTE and our Mendelian randomization studies need to be revisited?? Read more.
The sci-fi we grew up with is now peer-reviewed!
Growing up, we watched many sci-fi movies and TV series; a new bot that does this and that, or a bionic that did so and so…well, sci-fi no more! AI and LLMs are already at the cusp of what sci-fi movies showed, if not beyond that. In a recent issue of NEJM, scientists reported a phase I gene editing experiment in 35 individuals that resulted in major reductions in PCSK9 levels and LDL cholesterol. Is it durable? How’s the long-term safety? Will it result in improved outcomes? All fair questions, but for now, pretty interesting—scary interesting!! Read more.
Which P2Y12 inhibitor do we use after PCI?
There are dozens of RCTs and as many, if not more, meta-analyses of these RCTs. Just when we thought we had the answer, there’s another meta-analysis coming out, concluding that prasugrel might be the better agent in many patients with CAD undergoing PCI. I’m not yet sure if we have all the answers—and personally think there is some way that we should incorporate genetic and platelet function data (with the caveat that existing studies are less than definitive and we have to find better ways in future). But for now, here you go with food for thought!