Clot, Clot, Who's There?

More tools. New evidence. Tough decisions. With the 2026 AHA/ACC pulmonary embolism (PE) guidelines as a backdrop, when is anticoagulation enough, and when is it time to reach for advanced therapy?

Behnood Bikdeli, Jane Leopold, Lisa Moores, and Suresh Vedantham return to take on the treatment questions that follow risk assessment. From fibrinolysis and mechanical thrombectomy to extracorporeal membrane oxygenation (ECMO), the panel weighs what the trials tell us, where uncertainty remains, and what matters at the bedside. Two patient cases put bleeding risk, clot anatomy, clinical trajectory, resources, and patient preferences into the mix.

Episode chapters

00:00 Welcome and the Advanced PE Therapy Toolkit 03:06 Fibrinolysis and Thrombectomy: What the Trials Show 11:25 ECMO and Immediate Priorities in High-Risk PE 16:55 Choosing an Intervention: Bleeding Risk, Anatomy, and Resources 20:09 Case Discussions: Anticoagulation Alone or Advanced Therapy? 27:31 Practical Takeaways

Thank you to our sponsor, Penumbra, for their generous support of this podcast episode. All content was independently developed by Vasculearn Network and the expert panel.

Missed the first conversation? Check out Part 1: PE Risk Stratification to explore the new framework and how to spot patients who may be heading toward trouble.

The blood pressure looks reassuring, but is it telling the whole story? In acute pulmonary embolism (PE), the next few hours can matter as much as the first set of vital signs.

Behnood Bikdeli joins experts Jane Leopold, Lisa Moores, and Suresh Vedantham to unpack the 2026 AHA/ACC PE guidelines and put the new risk-stratification framework to work. With two patient cases and practical bedside insights, the panel explores who needs a closer watch, when to mobilize a response team, and how to stay ahead of a patient who may be heading in the wrong direction.

Episode chapters

00:00 The New PE Risk-Stratification Framework 06:21 Assessing Risk: Vital Signs, Biomarkers, Imaging, and Scores 11:22 Turning Risk Assessment Into Action: PERT, Monitoring, and Preparedness 18:47 Timing, Resources, and Transfer Decisions 21:59 Case 1: A Stable Presentation With Signs of RV Strain 27:32 Case 2: Transient Hypotension, Closer Monitoring, and Acute-on-Chronic Clues

Thank you to our sponsor, Penumbra, for their generous support of this podcast episode. All content was independently developed by Vasculearn Network and the expert panel.

What comes after risk assessment? Check out Part 2, where the panel weighs the evidence behind advanced therapies and tackles when—and how—to intervene.

GLP-1s are transforming the treatment of diabetes and obesity, but could their benefits extend to venous thromboembolism (VTE)? And what should clinicians tell patients with a history of VTE?

Join host Julia Sandrin Gauer and experts Christian Ruff and Rushad Patell as they discuss:

• What current evidence suggests about GLP-1 therapies and VTE risk • The limitations of existing clinical trial and observational data • Whether GLP-1 and multi-incretin therapies may have different effects • What these findings mean for clinical practice, and the questions that remain

Tune in now to this special collaboration between the ISTH Pulse Podcast and Vasculearn Network's Clot, Clot, Who's There?, for this timely conversation!

Your patient is bleeding or needs urgent surgery, but no one knows when the last DOAC dose was taken. Is there still enough factor Xa inhibitor on board to change what happens next?

Join experts Alex Spyropoulos, Christopher Baugh, and Deborah Siegal as they discuss:

• Why stabilization must come before laboratory confirmation

• The limitations of routine coagulation tests

• How to interpret drug-specific and heparin-calibrated anti-Xa assays

• Practical pathways for major bleeding and urgent surgery

• The future of rapid point-of-care testing

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations in thrombosis, hemostasis, and vascular medicine.

00:00: Assessing Residual Factor Xa Activity

03:41: Stabilize First, Test Second

08:56: Lab Testing: Options and Limitations

18:20: Major Bleeding vs. Urgent Surgery

21:54: The Future of Point-of-Care Testing

Thank you to our sponsor, VarmX, for their generous support of this podcast episode.

Check out the companion learning course, No Time To Wait: Urgent Situations in Patients on Factor Xa Inhibitors, here.

Factor Xa inhibitors have transformed anticoagulation, but urgent bleeding or surgery may require decisions before clinicians know when the last dose was taken or how much anticoagulant activity remains.

Join experts Alex Spyropoulos, Eduardo Ramacciotti, and Preston Hewgley as they discuss:

• Why residual factor Xa inhibitor activity matters in urgent care

• How an unknown last dose complicates clinical decisions

• Why bleeding risk persists despite DOAC advantages over warfarin

• How to balance bleeding, thrombosis, and surgical urgency

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations in thrombosis, hemostasis, and vascular medicine.

00:00: Residual Factor Xa Activity: Why It Matters

01:38: Unknown Last Doses and Urgent Decisions

09:47: Major Bleeding and Urgent Surgery

14:03: Reversal, Treatment Delays, and Outcomes

Thank you to our sponsor, VarmX, for their generous support of this podcast episode.

Check out the companion learning course, No Time To Wait: Urgent Surgery in Patients on Factor Xa Inhibitors, here.

The COBRRA Trial and the Questions that Remain

Clinicians have long relied on indirect comparisons when choosing between direct oral anticoagulants (DOACs) for VTE. The COBRRA trial changed that.

Join experts Behnood Bikdeli, Lana Castellucci, and David Jiménez as they discuss:

• The landmark COBRRA trial and its implications for VTE treatment

• How bleeding risk, adherence, and patient preferences influence DOAC selection

• When alternatives to apixaban may still be preferred

• The challenges of conducting head-to-head anticoagulation trials

• Global barriers to DOAC access and the next unanswered questions in the field

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations bridging science, practice, and global perspectives in thrombosis, hemostasis, and vascular medicine.

00:00: Introduction to COBRRA and the First Head-to-Head DOAC Comparison

03:58: Apixaban vs. Rivaroxaban: Key Findings and Clinical Implications

09:45: Adherence, Special Populations, and Choosing the Right DOAC

14:18: Why Did It Take So Long? Designing and Conducting the COBRRA Trial

19:05: Global Access, Reimbursement Challenges, and Real-World Use of DOACs

23:12: The Next Frontier: COBRRA-AF and Remaining Research Questions

When a young, otherwise healthy patient presents with an upper extremity DVT, venous thoracic outlet syndrome should be high on the differential—but the diagnosis is often delayed or missed.

Join experts JoMarie Monzon, MSN, FNP-BC and Drs. Donna Bahroloomi, Ali Azizzadeh, and Vincent Jongkind as they discuss:

• Why venous thoracic outlet syndrome is frequently mistaken for musculoskeletal injury

• Diagnostic challenges and the role of imaging

• Current approaches to thrombolysis, decompression, venous reconstruction, and anticoagulation

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations bridging science, practice, and global perspectives in thrombosis, hemostasis, and vascular medicine.

00:00: Introduction to Venous Thoracic Outlet Syndrome (VTOS)

05:37: Diagnosing VTOS & Understanding the Different Subtypes

10:26: Thrombolysis, Anticoagulation, and Timing of Decompression

14:45: Surgical Approaches, Vein Reconstruction, and Long-Term Outcomes

22:20: Postoperative Anticoagulation Strategies

24:28: Key Clinical Takeaways

In urgent, high-stakes situations—like major bleeding or emergency surgery—how should clinicians assess coagulation in patients on factor Xa inhibitors? And more importantly, are we focusing on the right signal?

Join global experts as they explore:

• Why traditional assays (PT/aPTT, anti-Xa) often fall short in critical decision-making

• The role of functional testing in assessing true hemostatic potential

• How VMX-C001, a novel bypassing agent, challenges conventional approaches to reversal and monitoring

Be sure to read the VMX-C001 study discussed in the episode: https://www.rpthjournal.org/article/S2475-0379(26)00033-6/fulltext?dgcid=raven_jbs_etoc_email

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations bridging science, practice, and global perspectives in thrombosis, hemostasis, and vascular medicine.

Chapters 00:00 Introduction & Clinical Challenge 02:54 Assessing Factor Xa Inhibitors in Urgent/Emergent Situations 05:29 Why Standard Assays Fall Short 09:38 Functional Testing: dPT & dRVVT 12:35 VMX-C001 & Future Directions

This episode was made possible through generous support from VarmX.

Surviving a stroke is only the beginning. Preventing the next one is where the real clinical challenge lies—and for patients with non-cardioembolic stroke, the existing toolkit has long fallen short.

Join Drs. Geoff Barnes, Mike Sharma, and Valeria Caso as they explore:

• Stroke subtypes, recurrence risk, and the unique challenges of non-cardioembolic stroke and ESUS

• Why current treatment options have fallen short—and what may be next

• The advent of Factor XI inhibitors and what emerging data may mean for the future of secondary prevention

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations bridging science, practice, and global perspectives in thrombosis, hemostasis, and vascular medicine.

• 00:00: Introduction & Stroke Subtypes

• 03:59: Recurrence Risk & Key Risk Factors

• 07:24: Current Treatment Strategies

• 10:54: ESUS & Limits of Anticoagulation

• 14:19: Moving Beyond Aspirin

• 16:26: Factor XI Inhibitors: Data & Future Directions

This episode was made possible through generous support from Bayer.

When it comes to antithrombotic therapy in coronary artery disease, the central question is no longer "What should everyone get?" It's "What's right for this patient?"

In this episode, Drs. Heather Johnson, Ty Gluckman, and Davide Cappodano explore the modern balance between managing clotting and bleeding risk in patients on antiplatelets and anticoagulants. From the evolving role of aspirin and P2Y12 monotherapy to dual pathway inhibition and the management of CAD with atrial fibrillation, the conversation highlights a clear shift: less one-size-fits-all medicine, more individualized—and shared—decision-making.

Tune in now and subscribe to Clot, Clot, Who's There? for more expert conversations bridging science, practice, and global perspectives in thrombosis, hemostasis, and vascular medicine.

00:00 – Welcome & Introduction

03:57 – Is Aspirin Still King?

10:26 – Shorter DAPT, Earlier Monotherapy

14:09 – When More Is More: the COMPASS regimen

17:49 – When Less Is More: CAD + AF