YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism in Patients With Cancer
Akerboom B et al. JAMA (July 2026)
Bottom Line: The Hydra study was an open-label, randomized, noninferiority trial conducted from August 22, 2019, to August 21, 2025, involving 698 patients with active cancer and suspected acute pulmonary embolism (PE). Participants were randomly assigned to receive diagnostic management by the YEARS algorithm or CTPA only. The primary outcome was symptomatic venous thromboembolism or (possible) PE-related death within 90 days, with results showing 1.8% in the YEARS group and 5.5% in the CTPA group. The study concluded that the YEARS algorithm is as safe as CTPA, eliminating the need for CTPA in 22% of patients.
Intermediate dose heparin thromboprophylaxis among critically ill patients with COVID-19
REMAP-CAP Investigators. Journal of Thrombosis and Haemostasis (July 2026)
Bottom Line: This ongoing adaptive platform trial evaluates the effectiveness and safety of intermediate-dose heparin versus standard low-dose thromboprophylaxis in critically ill adults with COVID-19. A total of 1255 patients were enrolled across 78 sites in 15 countries, with interventions lasting up to 14 days. The primary outcome was organ support-free days (OSFDs) through 21 days, showing a 73.5% probability of improvement with intermediate-dose heparin (OR, 1.06; 95% credible interval, 0.87, 1.30). Major bleeding rates were 1.7% in the intervention group and 2.1% in the comparator group. The study concluded that intermediate-dose heparin did not improve OSFDs or survival compared to standard thromboprophylaxis.
Rivaroxaban Then Aspirin vs. Aspirin Alone after Total Hip or Knee Arthroplasty
Shivakumar S et al. NEJM (July 2026)
Bottom Line: This multicenter, double-blind, randomized, controlled trial evaluated the effectiveness and safety of aspirin alone versus an initial 5-day course of rivaroxaban followed by aspirin for venous thromboembolism (VTE) prophylaxis after total hip or total knee arthroplasty. A total of 5,429 patients were randomized to receive either aspirin (81 mg daily) or rivaroxaban (10 mg daily) for the first 5 postoperative days, after which all patients received aspirin for the remainder of prophylaxis (9 additional days after knee arthroplasty and 30 additional days after hip arthroplasty). The primary outcome was symptomatic VTE within 90 days. VTE occurred in 0.48% of patients in the aspirin-alone group and 0.45% in the rivaroxaban–aspirin group (risk difference 0.02%; 95% CI, −0.34 to 0.39; P<0.001 for noninferiority). Major or clinically relevant nonmajor bleeding was similar between groups (1.66% vs. 2.04%). The study concluded that aspirin alone was noninferior to an initial short course of rivaroxaban followed by aspirin for preventing symptomatic VTE after hip or knee arthroplasty, with no significant difference in bleeding.
Thrombo Trial Files Issue #TBO-2026-05
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