What's Hot in Clots: October 2025

Can’t believe that it’s already fall!! Here are my summaries for this month.

When to restart anticoagulation in patients with ischemic stroke in the setting of AF

One wonders when the right time may be to (re)start anticoagulation in patients with ischemic stroke whose event is thought to have been due to atrial fibrillation. This gets trickier considering that some patients receive reperfusion, including fibrinolysis (which is a major bleeding risk factor). Several clinical trials were recently performed, and this individual participant data meta-analysis addressed some key related aspects. Briefly, initiating a direct oral anticoagulant (DOAC) within 4 days is associated with better outcomes than delayed initiation. Read more.

Superficial vein thrombosis: Who cares??!!

In the face of it, superficial vein thrombosis (SuVT) may seem like an innocuous condition. And in fairness, it’s not associated with immediate or serious complications in many cases. However, it’s really not that simple. Some cases may need full-dose anticoagulation or merit low-intensity anticoagulation—but all cases deserve careful evaluation, removal of transient provoking factors (e.g., IV catheters), and appropriate symptomatic therapy. Read more.

Bonus point: I insist on abbreviating this condition as SuVT not “SVT,” which reminds almost all cardiologists of supraventricular tachycardia.

Anticoagulation in patients with PAH: Yes? No? Maybe?

Based on old observational data in an era of limited therapeutics, anticoagulation became a standard treatment for patients with pulmonary artery hypertension. This recent multicenter French study—paired with a pooled analysis of other observational comparative effectiveness studies—questions such practice. I think it’s time for a randomized controlled trial! Read more.

DAPT for CAD: How did we get here?

This is a very nice review paper that reviews the history of clinical studies for considering dual antiplatelet therapy for CAD. I particularly found the illustrations to be highly informative! Read more.

Catheter-associated thrombosis: Should we keep searching?

An in-vitro study raises concern that unfractionated heparin was the only agent to suppress catheter-initiated thrombin generation at clinically achieved concentrations. I’m aware that some experts are concerned about DOACs for treating catheter-associated thrombosis. Clinical studies are evaluating XI/XIa inhibitors. But if these in-vitro concerns are true, should we search for other therapies? What about warfarin?  Read more.

Behnood Bikdeli, MD, MS