What's Hot in Clots: November 2025

Here are my summaries for this month—nothing spooky, but hope you enjoy them!

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 snowstorm? 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

Speaking of the devil, 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 not the answer, for sure. Read more.

DOACs better than DAPT after left atrial appendage closure

This is now the second trial that we’ve covered demonstrating this finding. Read more. 

Tirofiban after fibrinolysis for stroke

Okay, this was from over the summer but I just noticed it. Why do I care? The story of IIb/IIIas in acute coronary syndromes has almost completely ended, maybe except 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, critical care medicine (or cardiology) is not my area of expertise. Second, this is strictly not a “What’s Hot in Clots” topic…and yet, I found it so interesting and think it fits within the spirit of Vasculearn Network! 

Don’t expect me to cover non-thrombosis papers frequently, but this took me by major surprise. Before I opened the link, I said to myself, “is this even a question? Of course they need an A-line.” 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