geoffrey modest medical blogs

  A recent study found that aspirin was actually harmful in patients with chronic coronary syndrome who were at high atherothrombotic risk and were on long-term anticoagulation, in the AQUATIC trial (Assessment of Quitting versus Using Aspirin Therapy in Patients with Stabilized Coronary Artery Disease after Stenting Who Require Long-Term Oral Anticoagulation. a bit of a mouthful....) in this French study: see   aspirin plus anticoag NEJM2025  in dropbox, or DOI: 10.1056/NEJMoa2507532     -- "chronic coronary syndrome" is the new name for "stable coronary artery disease" Details : -- 872 adults were eligible who had documented chronic coronary syndrome with previous coronary stent implantation more than 6 months before enrollment, had features of high residual atherothrombotic risk, and were receiving an oral anticoagulant (either a direct oral anticoagulant DOAC or a vitamin K antagonist VKA) for any reason.     --inclusion criteria: high-ri...

A recent South Korean study found that some patients who had catheter ablation for atrial fibrillation were able to discontinue anticoagulation therapy, in the ALONE-AF trial (Anticoagulation One year after Ablation of Atrial Fibrillation in Patients with Atrial Fibrillation (see afib ablation stop anticoag after 1 yr JAMA2025 in dropbox, or doi:10.1001/jama.2025.14679) Details: -- 850 adults aged 19 to 80 were enrolled in this open-label randomized controlled trial from 2020 the 2023 at 18 hospitals in South Korea, with follow-up until 2025 -- All enrollees had atrial fibrillation (AF) with catheter ablation and were put on anticoagulation as per usual; they were in intermediate or high risk of thromboembolism with a CHA2DS2-VASc score of at least 1 for men or 2 for women -- All had at least one non-sex-related stroke risk factor as determined by their CHA2DS2-VASc score and no documented recurrence of atrial arrhythmia for at least one year after their catheter ablation for AF ...

  A recent article found that adults with a provoked venous thromboembolism (VTE) and enduring risk factors are still at risk for a recurrent VTE event and do benefit from long-term anticoagulation, in the company-funded HI-PRO study  (see  dvt provoked prolonged anticoag NEJM2025  in dropbox, or DOI: 10.1056/NEJMoa2509426)   Details : -- 600 adults who had had an objectively-confirmed symptomatic venous thromboembolism (VTE) after a transient provoking risk factor (eg, autoimmune disorders, chronic lung disease, obesity) and had completed the at least 3-month course of anticoagulation were randomized to apixaban 2.5mg twice a day vs placebo for 12 months, in this single-center, double-blind trial done at the Brigham and Women's Hospital in Boston from November 2020 through November 2023 --mean age 59.5, 57% female, 81% white/12% Black/ 9% Latino -- BMI 31, current smokers 5%  -- coexisting conditions: VTE prior to this trial in 21%; diabetes...