1 | Cho MS, Kang DY, Ahn JM, et al. Edoxaban antithrombotic therapy for atrial fibrillation and stable coronary artery disease. N Engl J Med 2024; 391:2075–86. https://doi.org/10.1056/NEJMoa2407362. In patients with atrial fibrillation and stable coronary artery disease, edoxaban monotherapy led to a lower risk of a composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, or major bleeding or clinically relevant nonmajor bleeding at 12 months than dual antithrombotic therapy.
2 | Joosten LPT, van Doorn S, van de Ven PM, et al. Safety of switching from a vitamin K antagonist to a non-vitamin K antagonist oral anticoagulant in frail older patients with atrial fibrillation: results of the FRAILAF randomized controlled trial. Circulation 2024;149:279–89. https://doi.org/10.1161/ CIRCULA-TIONAHA.123.066485. Switching international normalized ratio– guided VKA treatment to an NOAC in frail older patients with atrial fibrillation was associated with more bleeding complications compared with continuing VKA treatment, without an associated reduction in thromboembolic complications.
3 | Werring DJ, Dehbi HM, Ahmed N, et al. Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): a multicentre, blinded-endpoint, phase 4, randomised controlled trial. Lancet 2024; https://doi. org/10.1016/S0140-6736(24) 02197-4. Early DOAC initiation within 4 days after ischaemic stroke associated with atrial fibrillation was non-inferior to delayed initiation for the composite outcome of ischaemic stroke, intracranial haemorrhage, unclassifiable stroke, or systemic embolism at 90 days.
4 | Ge Z, Kan J, Gao X, et al. Ticagrelor alone versus ticagrelor plus aspirin from month 1 to month 12 after percutaneous coronary intervention in patients with acute coronary syndromes (ULTIMATE-DAPT): a randomised, placebo- controlled, double-blind clinical trial. Lancet 2024;403:1866–78. https://doi. org/10.w1016/S0140-6736(24)00473-2. In patients with an acute coronary syndrome who had percutaneous coronary intervention with contemporary drug-eluting stents and remained event-free for 1 month on dual antiplatelet therapy, treatment with ticagrelor alone between month 1 and month 12 after the intervention resulted in a lower rate of clinically relevant bleeding and a similar rate of MACCE compared with ticagrelor plus aspirin. Along with the results from previous studies, these findings show that most patients in this population can benefit from superior clinical outcomes with aspirin discontinuation and maintenance on ticagrelor monotherapy after 1 month of dual antiplatelet therapy.
5 | Natsuaki M, Watanabe H, Morimoto T, et al. An aspirin-free versus dual antiplatelet strategy for coronary stenting: STOPDAPT-3 randomized trial. Circulation 2024;149: 585–600. https://doi.org/10.1161/ CIRCULATIONAHA. 123.066720. The aspirin-free strategy using low-dose prasugrel compared with the DAPT strategy failed to attest superiority for major bleeding within 1 month after PCI but was noninferior for cardiovascular events within 1 month after PCI. However, the aspirin-free strategy was associated with a signal suggesting an excess of coronary events.
6 | Watanabe H, Natsuaki M, Morimoto T, et al. Aspirin vs. clopidogrel monotherapy after percutaneous coronary intervention: 1-year follow-up of the STOPDAPT-3 trial. Eur Heart J 2024;45:5042–54. https://doi. org/10.1093/ eurheartj/ehae617. Aspirin monotherapy compared with clopidogrel monotherapy was associated with similar cardiovascular and bleeding outcomes beyond 1 month and up to 1 year after percutaneous coronary intervention with drug-eluting stents.
7. | van Ginkel DJ, Bor WL, Aarts HM, et al. Continuation versus interruption of oral anticoagulation during TAVI. N Engl J Med 2024;392:438–49. https://doi.org/10.1056/NEJMoa2407794 8. In patients undergoing TAVI with a concomitant indication for oral anticoagulation, periprocedural continuation was not noninferior to interruption of oral anticoagulation during TAVI with respect to the incidence of a composite of death from cardiovascular causes, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days.
8 | Jaber WA, Gonsalves CF, Stortecky S, et al. Large-bore mechanical thrombectomy versus catheter-directed thrombolysis in the management of intermediate-risk pulmonary embolism: primary results of the PEERLESS randomized controlled trial. Circulation. 2024;151:260–73. https://doi.org/10.1161/CIRCULATIONAHA. 124.072364. PEERLESS met its primary end point in favor of LBMT compared with CDT in treatment of intermediate-risk pulmonary embolism. LBMT had lower rates of clinical deterioration and/or bailout and postprocedural intensive care unit use compared with CDT, with no difference in mortality or bleeding.
9 | Vriesendorp PA, Nanayakkara S, Heuts S, et al. Routine protamine administration for bleeding in transcatheter aortic valve implantation: the ACE-PROTAVI randomized clinical trial. JAMA Cardiol 2024;9:901–8. https://doi.org/10.1001jamacardio.2024. In the ACE-PROTAVI randomized clinical trial, routine administration of protamine increased the rate of hemostasis success and decreased TTH. The beneficial effect of protamine was reflected in a reduction in minor vascular complications, procedural time, and postprocedural hospital stay duration in patients receiving routine protamine compared with patients receiving placebo.
10 | Luijten D, Douillet D, Luijken K, et al. Safety of treating acute pulmonary embolism at home: an individual patient data metaanalysis. Eur Heart J 2024;45:2933–50. The incidence of adverse events in hometreated PE patients, selected by a validated triage tool, was very low. Patients with cancer had a three- to five-fold higher incidence of adverse events and death. Patients with increased troponin or (NT-pro)BNP had a three-fold higher risk of adverse events, driven by recurrent venous thromboembolism and bleeding.
11 | Ruff CT, Patel SM, Giugliano RP et al. AZALEA–TIMI 71 Investigators. Abelacimab versus rivaroxaban in patients with atrial fibrillation. N Engl J Med 2025;392:361–71. Among patients with atrial fibrillation who were at moderate-to-high risk for stroke, treatment with abelacimab resulted in markedly lower levels of free factor XI and fewer bleeding events than treatment with rivaroxaban.
12 | Piccini JP, Patel MR, Steffel J, et al. Asundexian versus apixaban in patients with atrial fibrillation. N Engl J Med 2025;392:23–32. Among patients with atrial fibrillation at risk for stroke, treatment with asundexian at a dose of 50 mg once daily was associated with a higher incidence of stroke or systemic embolism than treatment with apixaban in the period before the trial was stopped prematurely. There were fewer major bleeding events with asundexian than with apixaban during this time.
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