Episode 5: Assessment and guideline recommendations for recurrent VTE in patients without cancer
Thrombosis in conversationShow Notes
“Why did a patient get their blood clot in the first place, and how does that influence our decisions?” Dr Barnes is joined by Dr Anita Rajasekhar for a discussion of the causes and risk factors of VTE in people without cancer, and the relationship of risk and cause with treatment selection. With reference to clinical guidance, Dr Rajasekhar talks about diagnosis of recurrent VTE in the clinical setting and the importance of patient preference.
More from 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.