Thrombosis in conversation

“Nobody ever said to me, ‘How are you doing?’ – which I think would have made a big difference.” Dr Barnes welcomes Leslie Lake, VTE survivor and volunteer president of the National Blood Clot Alliance, for a powerful conversation focused on the patient experience. Leslie shares her journey from a sudden pulmonary embolism and delayed diagnosis to living with the emotional impact of VTE. The discussion highlights the need for clinician awareness, the importance of ongoing risk assessment, and efforts to improve equity and access in blood clot care.

“I am sure 2026 is going to be even more exciting.” Dr Behnood Bikdeli joins Dr Barnes to discuss major advances in VTE and AF management in 2025, including the impact of trials such as API-CAT, RENOVE, and HI-PRO in VTE, and AMAFI, OPTION, and ADAPT-DES in AF. Highlights include the shift towards treatment personalisation and a “less is more” approach in clinical practice.

“Just being upfront with patients about those areas of uncertainty can be really helpful…” Dr Deborah Siegal and Dr Barnes break down best practices for balancing safety and efficacy when deciding how long to continue anticoagulation therapy for thrombosis. They discuss ways to reassure patients during an uncertain time, highlight key factors that modify bleeding risk, and explain how ongoing follow-up and reassessment are important in driving better outcomes. 

“I think this was such an important trial, certainly one that has changed my practice already.” Dr Barnes welcomes Dr Marco Proietti for a review and discussion of key studies presented at ESC 2025, including AMALFI, ALONE-AF, and HI-PRO. Which results were practice-changing, which were reassuring, and which are of uncertain value or highlight a need for new therapeutics?

“We must be patient centred.” Dr Steven Deitelzweig and Dr Barnes address the challenge of balancing bleed risk and thrombosis prevention in special populations, such as those with obesity, frailty, or chronic kidney disease. With up to 50% of patients not resuming anticoagulation following a bleed, they emphasise the importance of shared decision-making to guide treatment in patients for whom the evidence is uncertain.

What makes good real-world evidence (RWE), and why does it matter? Dr Steven Deitelzweig joins Dr Barnes to discuss how physicians can assess the quality of RWE and its potential to expand our understanding of the safety and effectiveness of treatments beyond clinical trial data, helping to guide anticoagulation in understudied populations.

“As soon as you have a cancer diagnosis, the odds [of VTE] increase 4-fold, 6.5-fold if that particular patient is initiating chemotherapy.” Dr Marc Carrier and Dr Geoffrey Barnes use a case study to talk through the decision-making process and specific needs for anticoagulation in patients with cancer. They highlight the need for a multidisciplinary approach, how tools such as the Khorana score inform treatment, and the patient group that rarely receives thromboprophylaxis despite having a number needed to treat of just 25 to prevent one clot.

Around 50% of patients eligible for anticoagulation treatment do not meet the usual inclusion criteria for randomised controlled trials (RCTs). Dr Marc Carrier joins Dr Barnes for a discussion of three recent RCTs with a pragmatic approach – CANVAS, RENOVE, and ONCO PE – and how these have addressed important questions about the clinical approach to CAT, including how long to continue direct oral anticoagulation (DOAC) treatment and whether to reduce the dose.

“We have to be careful about who we label with chronic kidney disease.” Dr Piazza returns to talk to Dr Barnes about renal dysfunction in the context of AF, including the factors to consider to ensure a clinically relevant diagnosis, why intentional underdosing of anticoagulants may do more harm than good, and the use of warfarin versus direct oral anticoagulants in patients with end-stage renal disease.

Clinical pharmacist Dr Arthur Allen joins Dr Barnes to discuss how to navigate transitions between anticoagulants, including when and why to use bridging low-molecular-weight heparin, the patient characteristics that may influence management, and why switching guidance in the prescribing information is not practical. Also, amid local variations in care models and cultures, what is the key factor that can determine the success of physician–pharmacist collaborative care?