Objective: To investigate the clinical characteristics and antithrombotic treatment strategies in patients with acute ST-segment elevation myocardial infarction (STEMI) who develop new-onset atrial fibrillation during the acute phase and undergo emergency percutaneous coronary intervention (PCI), and to evaluate the association between new-onset atrial fibrillation and prognosis in STEMI patients. Methods: This retrospective cohort study consecutively enrolled 142 STEMI patients with atrial fibrillation who underwent coronary angiography and emergency PCI via the emergency green channel at the Department of Cardiology, General Hospital of Northern Theater Command from March 2016 to March 2022. Patients were divided into two groups based on the presence of new-onset atrial fibrillation: the prior atrial fibrillation group (n=61) and the new-onset atrial fibrillation group (n=81). Clinical baseline data, in-hospital and long-term antithrombotic strategies after discharge, and adverse events during follow-up were recorded and compared between the two groups. Multivariate Cox regression analysis was used to assess the association between new-onset atrial fibrillation and adverse outcomes. Results: The mean age of the 142 STEMI patients was (68.0±11.5) years, with 104 males accounting for 73.2%. New-onset atrial fibrillation accounted for 57.0% (81/142) of the patients. Compared with the prior atrial fibrillation group, patients in the new-onset atrial fibrillation group were younger, had a lower prevalence of diabetes and previous stroke, and had lower CHA2DS2-VASc and HAS-BLED scores. Additionally, a higher proportion of patients in the new-onset atrial fibrillation group presented with Killip class Ⅳ at admission. During hospitalization, the new-onset atrial fibrillation group had a higher proportion of amiodarone use and lower prescription rates of angiotensin-converting enzyme inhibitors or angiotensin Ⅱ receptor blockers. Regarding long-term antithrombotic strategies after discharge, patients in the new-onset atrial fibrillation group more frequently received dual antiplatelet therapy (67 (82.7%) vs. 37 (60.7%)), while those in the prior atrial fibrillation group more often received anticoagulation combined with dual antiplatelet therapy (20 (32.8%) vs. 8 (9.9%), P<0.05). During 12-month follow-up, the incidence of net adverse clinical events was 18.5% (15/81) in the new-onset atrial fibrillation group and 24.6% (15/61) in the prior atrial fibrillation group, with no significant difference between the two groups (P>0.05). Multivariate Cox regression analysis confirmed that new-onset atrial fibrillation was not independently associated with adverse outcomes (HR=0.73, 95%CI: 0.31-1.69, P=0.459). Conclusions: More than half of the STEMI patients with atrial fibrillation undergoing emergency PCI had new-onset atrial fibrillation, characterized by a lower prevalence of diabetes and stroke, as well as a greater likelihood of receiving dual antiplatelet therapy as the long-term post-discharge antithrombotic strategy. However, new-onset atrial fibrillation was not independently associated with adverse outcomes.

Assessment of in-hospital mortality in patients with upper gastrointestinal bleeding on antithrombotic treatment: A Systematic Review and Meta-Analysis.

Patients surviving spontaneous intracerebral hemorrhage (ICH) who have indications for antithrombotic treatment face increased risks of both hemorrhagic and ischemic events. The aim of STATICH (Study of Antithrombotic Treatment After Intracerebral Haemorrhage) was to assess the safety and efficacy of long-term antithrombotic treatment after ICH. STATICH Antiplatelets (EudraCT 2014-002636-13; Unique identifier: NCT03186729) was a randomized, multicenter, open, blinded end point parallel-group trial, including adults with an indication for antiplatelet treatment to either start or avoid antiplatelet treatment. The target sample size was 500 participants. Patients were allocated 1:1 by a Web-based randomization system and followed for a minimum of 2 years. Outcome assessments were done by personnel blinded to treatment. Participants were not blinded. The primary safety outcome was recurrent symptomatic ICH. The trial was stopped early due to slow recruitment. Sixty-nine patients were included between August 2018 and December 2022: 34 were randomized to start antiplatelet treatment, and 35 were randomized to avoid antiplatelet treatment. No patients were excluded from analyses. The median age was 75 (Q1-Q3, 66-80) years, and 43 (75%) had previous ischemic stroke or transient ischemic attack. Five patients in the start antiplatelet treatment group (15% [95% CI, 6%-31%]), and 1 in the avoid group (3% [95% CI, 0%-18%]) experienced recurrent ICH, while 3 (9% [95% CI, 3%-24%]) and 7 (20% [95% CI, 10%-37%]), respectively, experienced a major ischemic event. A total of 88 serious adverse events and no suspected unexpected serious adverse reactions were registered. There were numerically more recurrent ICHs and fewer ischemic events in patients starting antiplatelet treatment after ICH compared with those avoiding antiplatelet treatment. The slow recruitment might be due to clinicians being certain of the best treatment strategy or patients being too frail to participate. STATICH will contribute to a planned collaborative individual patient-data meta-analysis to resolve this dilemma.

The relevance of prior antithrombotic and thrombolytic treatment for decision-making regarding endovascular thrombectomy (EVT) for acute ischemic stroke due to large vessel occlusion with established large infarcts is uncertain. This study investigates associations of prior antithrombotic medication and thrombolysis with the efficacy and safety of EVT for acute ischemic stroke due to large vessel occlusion with established large infarct. TENSION (Efficacy and Safety of Thrombectomy in Stroke With Extended Lesion and Extended Time Window) was a prospective randomized open-label blinded-end point clinical trial. Patients with acute ischemic stroke due to large vessel occlusion and established large infarct were randomized to EVT with medical therapy or medical therapy alone. Exposures were preadmission antithrombotic treatment with antiplatelet agents or anticoagulants and intravenous thrombolysis. The primary efficacy end point was functional outcome at 90 days. Safety outcomes included death and symptomatic intracranial hemorrhage. The study included 246 patients (median age, 74 years; interquartile range, 65 to 80 years; 49% women); 124 (50%) were assigned to EVT. Of 176 patients (72%) with prior antithrombotic therapy, 75 (31%) received antiplatelets, 56 (23%) anticoagulants, and 89 (36%) intravenous thrombolysis. EVT was associated with better functional outcome in patients with (common odds ratio [cOR], 2.40 [95% CI, 1.22-4.99]) and without (cOR, 2.29 [95% CI, 1.53-3.46]) antiplatelet therapy; with (cOR, 2.45 [95% CI, 1.17-5.28]) and without (cOR, 2.12 [95% CI, 1.44-3.15]) anticoagulation; as well as receiving (cOR, 1.46 [95% CI, 0.83-2.61]) and not receiving (cOR, 2.89 [95% CI, 1.87-4.51]) thrombolysis. Interaction analyses were consistent with similar treatment effects across subgroups. Mortality and rates of symptomatic intracranial hemorrhage were similar between groups. Benefit and safety of EVT were not modified by prior antithrombotic/thrombolytic therapy. Preadmission exposure to antiplatelets or anticoagulants or use of intravenous thrombolysis should not exclude eligible patients with stroke from EVT. URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03094715.

Anti-amyloid monoclonal antibodies have emerged as disease-modifying therapies for Alzheimer's disease. However, their broader clinical adoption is limited by amyloid-related imaging abnormalities, a key safety concern. Traditionally viewed as an unavoidable and dose-dependent adverse effect, amyloid-related imaging abnormalities often lead to treatment interruption or the exclusion of high-risk patients from therapy. Emerging evidence now suggests that amyloid-related imaging abnormalities may instead reflect a transient modifiable cerebrovascular response, primarily influenced by the kinetics of amyloid clearance rather than the absolute magnitude of amyloid removal. Recent data from titration-based dosing strategies demonstrate that gradual amyloid mobilization can significantly reduce the incidence of amyloid-related imaging abnormalities without compromising amyloid positron emission tomography responses or downstream biomarkers. This kinetic perspective may support a more nuanced re-evaluation of patient groups previously deemed unsuitable for therapy, including APOE ε4 carriers, individuals with cerebral microbleeds, and patients on antithrombotic treatment. In this Current Opinion, we propose a pragmatic clinical framework that integrates amyloid clearance kinetics, magnetic resonance imaging-based risk stratification, and individualized protocols for treatment interruption and re-challenge. By reframing amyloid-related imaging abnormalities as a modifiable clinical decision-making challenge rather than an inherent toxicity, anti-amyloid therapies may be optimized for safer use; however, whether such approaches can enable broader and more inclusive treatment strategies remains to be established in prospective studies, particularly in high-risk populations.

Early-event pathways to 6-month death or dependency after ischemic stroke: Secondary analysis of the international stroke trial.

Evaluating Blunt Cerebrovascular Injury Screening in High-Energy Trauma Patients: A Rural Trauma Center Study.

Natural products enriched in medicinal plants have broad prospects in addressing global public health challenges and meeting diverse human health needs. The traditional Chinese herbal medicine Notopterygii Rhizoma et Radix (NRR) is the dried rhizome and root of Notopterygium incisum Ting ex H. T. Chang, which is used to treat wind-cold-caused headaches, rheumatic disease, osteoarthritis, and anti-thrombotic treatment. Commonly, NRR collected from wild collection faces the issues of resource depletion and unstable quality. In this study, we investigated the phenotypical traits and bioactive components in the wild collected individuals of N. incisum to find and conserve the excellent germplasm. Results showed that the genetic diversity of N. incisum is rich and led to the high variation of the phenotypic traits, e.g., aboveground traits with coefficient of variation (CV) ranged from 21.3% ~ 55.5% and reproductive growth traits ranged from 34.7% to 90.5%, and bioactive pharmaceutical components, e.g., notopterol ranging from 0.02% to 1.27% and isoimperatorin ranging from 0.16% to 3.32%. According to the variation in bioactive pharmaceutical components, N. incisum was divided into three groups: high-quality, medium-quality, and low-quality group. The bioactive pharmaceutical components isoimperatorin and notopterol peaked at 2.38%, 0.83% in the high-quality group; in contrast, the lowest isoimperatorin and notopterol at 0.69% and 0.33% were obtained in the low-quality group. The Mantel test showed that basal leaf petiole length (r = 0.187, p < 0.05) and basal leaf width (r = 0.107, p < 0.05) were significantly affected by genetic diversity, which contributed to germplasm identification. This study integrates phenotypic characterization with chemical analysis to investigate the correlations between key traits and bioactive compounds in N. incisum. The high-quality group was characterized by robust vegetative growth and weak reproductive growth, while the low-quality group showed the opposite. The current research provides a potential practical reference method for screening high-quality germplasm resources of N. incisum. That is, the quality of N. incisum germplasm resources can be distinguished based on the strength of reproductive growth ability.

Pharmacists play a crucial role in managing antithrombotic therapy in critically ill adults; however, data on this topic in critically ill children are limited. Therefore, we sought to characterize the types of antithrombotic therapy interventions provided by pediatric pharmacists. Via a multicenter, prospective, observational study at 9 children's hospitals in the United States, pediatric pharmacists in the pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), mixed intensive care unit (ICU), and pediatric cardiac intensive care unit (PCICU) at participating centers recorded recommendations made during clinical activities during at least 20 shifts. Interventions were documented in a central REDCap database. Descriptive statistics were used to summarize the data. From July 2023 to November 2024, a total of 41 pediatric pharmacists from 9 participating institutions completed data collection on interventions during 697 shifts. A total of 12,632 accepted interventions for 2,264 patients were recorded. Among the 12,632 interventions, 1,130 (9%) were antithrombotic-related interventions, involving 693/2,264 (26.4%) patients. Most antithrombotic medication interventions occurred in the PCICU (844/1,130, 74.7%). Approximately half of the antithrombotic interventions were related to antithrombotic initiation/management (n = 607/1,130, 53.7%), with the majority involving an anticoagulant medication(s) (549/607, 90.4%). The majority of antithrombotic interventions in critically ill children were in the PCICU and involved anticoagulation for thromboembolism treatment and prevention. Further research is warranted to evaluate pediatric pharmacist-driven clinical services and the impact on antithrombotic outcomes in critically ill children, particularly those with cardiac disease.

In patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and who are treated with direct oral anticoagulants (DOACs), dual antithrombotic treatment without aspirin is recommended. Evidence comparing P2Y12 inhibitor strategies in this setting is limited. This study aimed to compare outcomes with ticagrelor versus clopidogrel as part of dual antithrombotic treatment in ACS patients undergoing PCI. Using data from the SWEDEHEART registry, we conducted a cohort study including patients on dual antithrombotic treatment with ACS undergoing PCI between January 2014 and February 2022. Outcomes within one year were analysed using multivariate Cox regression to obtain adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for major adverse cardiovascular events (MACE; including mortality, myocardial infarction [MI], and stroke), all-cause mortality, clinically relevant bleeding, and MI. A total of 3,708 patients were included (median age 76 years; 69% males; 40% ST-segment elevation myocardial infarction). At discharge, 1,170 (32%) received ticagrelor and 2,538 (68%) clopidogrel. For MACE, the unadjusted event rate was 16.7% in the ticagrelor group and 16.6% in the clopidogrel group (aHR 1.02, 95% CI: 0.84-1.23). Mortality occurred in 6.6% of patients treated with ticagrelor and 6.2% of those treated with clopidogrel (aHR 1.24, 95% CI: 0.91-1.69). Bleeding was 4.9% in the ticagrelor group compared with 3.7% in the clopidogrel group (aHR 1.53, 95% CI: 1.06-2.22). MI occurred in 10.4% of patients on ticagrelor and 11.2% of those on clopidogrel (aHR 0.90, 95% CI: 0.71-1.13). In ACS patients on DOACs undergoing PCI, ticagrelor was associated with an increased risk of bleeding compared with clopidogrel, with no differences in MACE, mortality, or MI.

Although cerebral venous thrombosis (CVT) has been widely studied in general clinical contexts, its occurrence after brain surgery raises specific concerns. CVT is a rare complication that may arise from sinus injury during brain surgery and is now increasingly recognized, due to frequent post-surgery imaging studies. There is also controversy over antithrombotic treatment in the acute phase. This narrative review analyzes the published literature on CVT in patients who underwent brain surgery, with a particular focus on diagnosis and therapeutic management. A PubMed search was conducted for articles published between 2014 and 2025. After title, abstract, and full-text screening, 32 studies were included. CVT after brain surgery is often asymptomatic and detected on routine postoperative imaging, but it should be suspected in the presence of symptoms of intracranial hypertension, seizures, or even delayed anesthesia recovery. Diagnosis relies primarily on plain CT or MRI plus CT or MR venography, with thrombophilia screening indicated when surgery alone does not justify sinus injury. Parenteral anticoagulation is the first-line treatment. Unfractionated heparin may be preferred over low molecular weight heparin in the first days after diagnosis because its effect is easier to reverse in case of emergency. Endovascular therapy may be considered in high-risk (large hemorrhage) or refractory cases. Intraoperatively, preventive measures include minimizing sinus injury and ensuring adequate hydration. Postoperative prophylactic anticoagulation should be considered in patients with known prothrombotic factors, weighing the thrombotic versus hemorrhagic risk. Overall, prognosis appears favorable, though evidence remains limited. CVT after brain surgery is rare and its management should be decided accordingly to the clinical particularities of each case. Evidence is limited and often extrapolated from general populations, highlighting the need for targeted research to improve outcomes and guide treatment decisions.

Patients with acute myocardial infarction (MI) and atrial fibrillation (AF) present challenges in antithrombotic treatment. Effects of newer treatment strategies on outcomes remain uncertain. We assessed implementation of antithrombotic treatment and occurrence of cardiovascular (CV) events and major bleeding in patients with MI and AF. Nationwide data from SWEDEHEART and national health registries were used to identify 71,513 survivors of an acute MI with AF between 2000-2021. Changes in antithrombotic therapies over time in 2-year cohorts were analysed, and associations with one-year outcomes were assessed. The outcomes were ischaemic stroke or systemic embolism, MI, major bleeding, CV mortality and all-cause mortality. Logistic regression was used to standardise for changes in patient characteristics and treatment over time. Oral anticoagulant use increased from 21% in 2000-2001 to 75% in 2020-2021, largely due to adoption of direct oral anticoagulants (DOACs) after the first DOAC approval in 2011, most often combined with a single antiplatelet. Over time, particularly in the last decade, one-year risk of ischaemic stroke or systemic embolism declined from 6.0% to 2.1%, and CV mortality decreased from 19.8% to 10.5%. Major bleeding increased from 3.9% to 7.6% in 2014-2015, then declined to 6.4% in 2020-2021, simultaneously with adoption of single rather than dual antiplatelet therapy in combination with DOAC. Between 2000 and 2021, among patients with MI and AF, we observed reductions in one-year risks of ischaemic stroke or systemic embolism and CV mortality, occurring during a period of increased prescription of oral anticoagulants, particularly DOACs.

Venous thromboembolism risk stratification, sex-related differences in dual antiplatelet therapy, and new targets for antithrombotic treatment.

Multiple trials have found no difference in secondary stroke prevention between anticoagulation and antiplatelet therapy after cryptogenic stroke. Due to limitations of current stroke mechanism classification, one possible explanation is the failure to exclude patients with hypertension-related cerebrovascular disease. To determine whether hypertension with high-risk features is associated with treatment effect modification of anticoagulation vs antiplatelet therapy. This exploratory analysis of the Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) randomized clinical trial was conducted between April and August 2025. The original trial was conducted from February 2018 to February 2023 at 185 sites in North America. From 1015 randomized patients with a recent cryptogenic stroke and atrial cardiopathy, 945 with available hypertension data were included in this analysis after exclusions for missing blood pressure and echocardiography data. Apixaban, 5 mg or 2.5 mg, twice daily vs aspirin, 81 mg, once daily. The primary outcome was recurrent ischemic stroke or systemic embolism. Hypertension with high-risk features was defined as systolic blood pressure ≥160 mm Hg at enrollment, left ventricular hypertrophy on echocardiography, or both. Cox proportional hazards models evaluated treatment interaction with hypertension with high-risk features and estimated hazard ratios within hypertension with high-risk features subgroups. Among 945 patients (mean [SD] age, 68.0 [10.8] years; 513 [54.3%] female), 351 (37.1%) met criteria for hypertension with high-risk features. Over a median (IQR) follow-up of 1.6 (0.7-3.0) years within the analytic cohort, 67 patients experienced a recurrent ischemic stroke or systemic embolism. A significant interaction between hypertension with high-risk features and antithrombotic treatment was observed. In 594 patients without hypertension with high-risk features, apixaban was associated with lower risk compared to aspirin (hazard ratio [HR], 0.43; 95% CI, 0.22-0.85; annualized rate difference: -3.4%), whereas no significant association was observed in patients with hypertension with high-risk features (HR, 1.68; 95% CI, 0.78-3.62; annualized rate difference: 2.4%). The findings in this study indicate that hypertension with high-risk features may be associated with modifications in the effect of antithrombotic treatment in patients with cryptogenic stroke. An unappreciated inclusion of strokes due to hypertensive arteriopathy may account for the lack of benefit with anticoagulation in prior trials of embolic stroke of undetermined source. ClinicalTrials.gov Identifier: NCT03192215.

Patterns of Antithrombotic Treatment after Left Atrial Appendage Occlusion

An effective antithrombotic strategy for patients with univentricular heart is required. We determined the prevalence of antithrombotic treatment and survival in patients with Fontan circulation, with secondary outcomes mortality, cardiovascular disease, acute myocardial infarction, and ischemic stroke. We retrospectively included patients with univentricular heart born in Sweden between January 1, 1970, and December 31, 2017. Data from the National Patient Register, the Cause of Death Register, and the Prescribed Drug Register were used. Patients who underwent total cavopulmonary connection surgery, resulting in Fontan circulation, were included and divided into groups based on treatment: anticoagulation, antiplatelets, and no antithrombotic therapy. In total, 864 patients (median [interquartile range] 14.4 [3.9-24.9] years follow-up) were included, 511 of whom (59%) were men. Thirty-six percent received no antithrombotic treatment, and the mortality rate during the follow-up was 58%. Among the patients treated with antithrombotic treatment, 75% received antiplatelets, with a 4% mortality rate. The mortality incidence rate was 2.40 (95% CI, 1.49-3.67) for antithrombotic treatment and 49.42 (95% CI, 42.50-57.15) without. The hazard ratio for mortality was 22.32 (95% CI, 14.04-35.48) without antithrombotic treatment. The incidence rate of ischemic stroke was 2.45 (95% CI, 1.52-3.75) with antithrombotic treatment and 2.47 (95% CI, 1.13-4.68) without. The incidence rate of acute myocardial infarction was 0.69 (95% CI, 0.25-1.50) with antithrombotic treatment and 2.76 (95% CI, 1.32-5.07) without treatment. Treatment with antiplatelets was associated with lower mortality compared with no antithrombotic treatment.

Cost-effectiveness of antithrombotic therapies for peripheral arterial disease.

Thromboembolic disorders remain a primary cause of mortality globally, with their burden expected to increase due to an aging population. While various antithrombotic agents exist, many patients still rely on traditional gold-standard drugs like heparin, warfarin, and aspirin, which present significant drawbacks. These include the need for injections, frequent monitoring, dietary restrictions, drug interactions, bleeding complications, or other adverse reactions such as thrombocytopenia. In contrast, direct oral anticoagulants offer advantages over warfarin, including fewer interactions and less need for continuous monitoring. However, even with newer drugs, patients face risks of major bleeding events. Current research focuses on novel antithrombotic agents with superior efficacy and enhanced safety compared to existing treatments. Researchers are exploring specific clinical niches, such as factor XI/XII inhibitors for cancer patients, to facilitate evaluation against standard treatments. The development of new antiplatelet drugs, like subcutaneous zalunfiban and selatogrel for pre-hospital therapy of myocardial infarction, and specific reversal agents, such as bentracimab for ticagrelor, exemplify this trend. Future research will likely focus on addressing the unmet needs of specific patient groups. This narrative review aimed to describe the current antithrombotic treatment and the most promising advances in the pharmacological management of thrombosis.

Abstract Introduction Best medical therapy (BMT), including antithrombotic and lipid-lowering treatment, is the standard of care for patients undergoing major lower limb amputation (MLLA), aiming to reduce major adverse cardiac events (MACE) and mortality. We assessed whether patients undergoing MLLA are receiving appropriate BMT. Methods This single-centre study included patients undergoing MLLA with clinical or radiological evidence of atherosclerosis. Medication use at admission and discharge was recorded. Triglyceride and LDL-C levels were measured at baseline, 3 months, and 6 months postoperatively. Results A total of 116 patients (81.9% male) were included. Comorbidities: diabetes (67.2%), hypertension (60.3%), heart failure (17.2%), and chronic kidney disease (28.5%). High-intensity statin use (75.0 to 82.5%, P = 0.0209) and ezetimibe increased significantly (6.9 to 11.3%, P = 0.0253). No patients were prescribed inclisiran, evolocumab, or icosapent ethyl, despite 10 meeting potential eligibility criteria. Antithrombotic use improved: full dose DOACs increased from 29.0 to 42.0% and warfarin from 0.9 to 2.7% (P &amp;lt; 0.001), COMPASS regimen increased from 12.9 to 21.4% (P = 0.0067). No statistical difference in single dose antiplatelet use was observed; patients receiving no antithrombotic therapy declined significantly (32 to 14, P &amp;lt; 0.001). Median LDL-C levels were 1.4 mmol/L baseline and at 6 months (P = 0.5443). Triglycerides levels increased 1.4 baseline to 2.0 mmol/L at 6 months (P = 0.1876). Conclusions While BMT prescribing improved following MLLA, adjunct lipid-lowering therapies remain underutilised reflected in no overall change in biochemical parameters. Broader implementation of full BMT is necessary to optimise cardiovascular risk reduction.

Recent advances of nanoparticles for ischemic stroke therapy.