“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.

What makes good real-world evidence (RWE), and why does it matter? Dr Steven Deitelzweig joins Dr Barnes to discuss how physicians can assess the quality of RWE and its potential to expand our understanding of the safety and effectiveness of treatments beyond clinical trial data, helping to guide anticoagulation in understudied populations.

“As soon as you have a cancer diagnosis, the odds [of VTE] increase 4-fold, 6.5-fold if that particular patient is initiating chemotherapy.” Dr Marc Carrier and Dr Geoffrey Barnes use a case study to talk through the decision-making process and specific needs for anticoagulation in patients with cancer. They highlight the need for a multidisciplinary approach, how tools such as the Khorana score inform treatment, and the patient group that rarely receives thromboprophylaxis despite having a number needed to treat of just 25 to prevent one clot.

Around 50% of patients eligible for anticoagulation treatment do not meet the usual inclusion criteria for randomised controlled trials (RCTs). Dr Marc Carrier joins Dr Barnes for a discussion of three recent RCTs with a pragmatic approach – CANVAS, RENOVE, and ONCO PE – and how these have addressed important questions about the clinical approach to CAT, including how long to continue direct oral anticoagulation (DOAC) treatment and whether to reduce the dose.

“We have to be careful about who we label with chronic kidney disease.” Dr Piazza returns to talk to Dr Barnes about renal dysfunction in the context of AF, including the factors to consider to ensure a clinically relevant diagnosis, why intentional underdosing of anticoagulants may do more harm than good, and the use of warfarin versus direct oral anticoagulants in patients with end-stage renal disease.

Clinical pharmacist Dr Arthur Allen joins Dr Barnes to discuss how to navigate transitions between anticoagulants, including when and why to use bridging low-molecular-weight heparin, the patient characteristics that may influence management, and why switching guidance in the prescribing information is not practical. Also, amid local variations in care models and cultures, what is the key factor that can determine the success of physician–pharmacist collaborative care?

Dr Piazza and Dr Barnes discuss how collaboration and a clear message can ease the transition from hospital to home, and the return to daily routines, for people recovering from VTE. Our experts discuss the optimal timing of thrombophilia testing, supporting medication adherence and getting patients moving again.

“We can definitely utilise each other’s strengths and expertise and make some synergy. We all have the same goal here.” Clinical pharmacist Dr Sara Vazquez and Dr Barnes discuss how physicians and pharmacists can collaborate to create more effective, individualised treatment approaches, and outline strategies to ensure patients are meaningfully involved in decisions about their treatment.

Dr Barnes and Dr Sara Vazquez consider the diverse factors that influence patients’ adherence to anticoagulant therapy, including “nuisance bleeding”, pill burden, and whether treatment is to prevent AF or VTE. They also look at different ways to build habits that can work for different individuals, and Dr Vazquez offers practical tips for effective communication with patients about their medications.

Artificial intelligence (AI) in cardiovascular care is empowering researchers and clinicians to uncover new findings that were previously undetectable. These data enable more sophisticated conclusions for guiding clinical decision-making. Dr Rohan Khera joins Dr Barnes to examine the present and future impact of AI technologies on the management of AF.

Dr Barnes and Dr Karlyn Martin discuss how recent data have informed opinions on the safety and efficacy of using direct oral anticoagulants (DOAC) in people with obesity and thrombosis. Dr Martin considers DOACs for people who have received bariatric surgery, and if guidelines for DOAC use in patients with comorbid obesity and VTE apply to other groups with thrombosis.

Host Dr Geoffrey Barnes and Dr Sara Vazquez review treatment options for stroke prevention in patient groups with AF and discuss overcoming patient and physician barriers to initiating optimal treatment. Dr Barnes observes: “Patients will often bring interesting stories that influence their ability to make a decision.”

Dr Geoffrey Barnes and Dr Gregory Piazza examine when ongoing weight-adjusted dosages are necessary in a patient with AF and obesity, best practices for monitoring renal function and medication levels, and specific lifestyle modifications.

Mitigating the risk of stroke in people with high bleeding risk can be a challenging balancing act. Dr Potpara and Dr Barnes discuss how these risks can be addressed, and how “patients should not be denied effective therapies because of concerns that can be managed in other ways”.

Dr Tatjana Potpara and Dr Barnes focus on managing stroke risk in older adults with AF, highlighting the clinical challenge of balancing bleeding risk with the benefits of anticoagulants.

Dr Jackson and Dr Barnes take a closer look at the hot topic of wearable devices in AF detection – their potential benefits and limitations – and how physicians can best discuss wearables with their patients.

Dr Larry Jackson and Dr Barnes consider how best to tackle a patient case study with a focus on optimal management of AF in older patients at high risk of bleeding.

Dr Barnes and Dr Frederik Verbrugge take a closer look at the management of stroke risk in people with AF and comorbid conditions.