What's Hot in Clots: November 2025

Here are my summaries for this month:

Fibrinolytic therapy for thromboembolic diseases

Have a patient with ischemic stroke in need of fibrinolysis? A clogged central venous catheter? DVT or PE? Or your primary PCI operator is stuck in a snow storm? We've got your back! This review paper summarizes the current best evidence and shares suggestions on future directions for the field. Read more.

Intracoronary alteplase in primary PCI

Yet another RCT on fibrinolytic therapy came out at TCT 2025. In a randomized trial of patients with STEMI and high thrombus burden, administration of 10 mg or 20 mg of alteplase into the infarct-related artery—after establishing the antegrade reperfusion—did not improve cardiovascular outcomes, and if anything, had a hint for harm. I don’t think the hypothesis is dead, but this agent and the current design is for sure not the answer. Read more.  

DOACs better than DAPT after left atrial appendage closure

This is now the second trial that we've covered that shows that DOACs are better than DAPT following LAA closure. Read more. 

Tirofiban after fibrinolysis for stroke

This came out over the summer but I just noticed it. Why do I care? Well, the story of IIb/IIIas in acute coronary syndromes is almost completely closed—except maybe for those with high thrombus burden or poor flow post-PCI, or other thrombotic complications during PCI. But now there seems to be a positive trial in stroke. Read more.

Deferring A-lines in critically ill patients with shock

I should share a couple of disclosures before talking about this trial. First, that critical care medicine (or cardiology) would not be my area of expertise. Second, this is strictly not “What’s Hot in Clots” material. And yet, I found it so interesting that I had to share—and I think it fits with the spirit of Vasculearn Network! Don’t expect me to cover non-thrombosis papers often, but this paper took me by major surprise.

Before I opened the link to the study, I was saying to myself, “Is this even a question? Of course they need an A-line (arterial catheter).” Guess what?? Deferring the A-line and relying on cuff blood pressure was noninferior with respect to a primary outcome of all-cause death by day 28. Read more.

Behnood Bikdeli, MD, MS