Key Updates in Thrombosis

There was a good mix of interesting publications in the field of thrombosis last month.

When to consider prophylactic anticoagulation after immobilization of lower extremity for trauma

Findings from a stepped-wedge cluster randomized controlled trial of 15 emergency departments in France and Belgium show that in patients with a low TRiP(cast) score, anticoagulation can be safely avoided without an excess risk of VTE. The one caveat is that bleeding events were not different. I asked asking myself “So, what?” Umm, maybe a small reduction in costs because of less frequent use of anticoagulants in the intervention group.. Read more.

Post-procedural anticoagulation after PCI for STEMI: Is it the RIGHT decision?

Findings from a multicenter randomized trial of 2,989 patients with STEMI from China does not suggest overall benefit from post-procedural anticoagulation. At a first glance, the findings are sobering, and in some ways at odds with a recent individual participant data pooled analysis of randomized trials that showed a reduction in cardiovascular events in patients treated with bivalirudin who received a high-dose post-PCI infusion. However, a closer look is warranted since in the current (RIGHT) trial, the post-procedural infusion of bivalirudin was fixed and not high dose. Read more.

Embolic stroke of unclear source: How can we improve the outcomes?

Another month and yet another randomized trial that’s unable to improve the outcomes of these patients. The ARCADIA trial was terminated prematurely after enrolling 1,015 patients due to futility. Apixaban and aspirin had identical incidence of recurrent stroke. Interestingly, there was a hint for interaction by sex, which may need further validation from other studies. Read more.

Direct oral anticoagulants (DOACs) after bariatric surgery: Do have a clear answer?

There has been continued debate about whether DOACs are a reasonable choice early after bariatric surgery. Authors of a research letter share pharmacokinetic/pharmacodynamic data about several patients. The accompanying Editorial addresses practical considerations for patients whose DOACs are continued, suggesting appropriate drug monitoring and switching in case of continued reliably low titers. Read more here and here.