What’s Hot in Clots.

To be aligned with the ongoing Olympics game, here are my three picks for this month:

For a while, pharmacists and clinicians have been concerned about enzyme-inducing anti-seizure medications being co-administered with direct oral anticoagulants (DOACs). The thinking has been that these medications may lead to lower DOAC levels and reduced effectiveness. A recent cohort study challenges this idea. I find this thought-provoking but will remain cautious until such results are verified by additional studies. Read more.

It is unquestionable that treating diseases from the comfort of one’s home is less costly and less disruptive to most patients. The only question is whether such a practice is safe. For PE, several individual studies had assessed the safety of early discharge or home treatment among patients deemed as low risk with the simplified Pulmonary Embolism Severity Index (sPESI) or Hestia criteria. However, those studies were small, leaving uncertainty about the safety of such practice. Now, in an individual participant, data-pooled analysis inclusive of more than 2600 patients, the authors show that early discharge is very safe, with a 30-day adverse event rate of 1.2%. In the accompanying Editorial, yours truly shares additional thoughts about this paper that provides the current best evidence on the topic. Read more  and the Editorial.

Telemonitoring programs seem promising and have been pursued with lots of enthusiasm over the past two decades. Findings from some programs for conditions such as heart failure, however, have been less than ideal. Now in this single-institution, randomized trial from the United Kingdom, the authors demonstrate the benefits of telemonitoring after discharge from hospitalization with an acute coronary syndrome (ACS). If there are no issues with costs and widespread availability, I think this can be a very helpful addition for our patients with ACS. Read more.