Undertreated anticoagulation: the stroke risk hiding in the dose

The edition in brief

An American Heart Association scientific statement (1 October) sets out the harm from antithrombotic undertreatment — omission, non-adherence and underdosing — in atrial fibrillation, venous thromboembolism and peripheral artery disease, linking it to higher rates of ischaemic stroke, systemic embolism, recurrent thrombosis and death, and calls for structured antithrombotic stewardship. A presidential advisory from the AHA with paediatric and obstetric societies (26 October) proposes a female life-stage framework — perimenarche, ovarian cycling, perimenopause and postmenopause — to organise cardiovascular screening and prevention in girls and women. A meta-analysis of 18 randomised trials (1,993 people) found wrist-worn wearable-guided remote or hybrid cardiac rehabilitation improved peak VO2 by 1.69 mL/kg/min, six-minute walk by 31 m and daily steps by about 1,060, but prediction intervals crossed zero, so benefit in a new programme is uncertain. A meta-analysis of three cohorts (669 exposed pregnancies) found no overall rise in major malformations after early SGLT2 inhibitor exposure (RR 0.94 versus insulin), with wide intervals and one cohort's signal for heart defects at weeks 4–10.