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The new recommendations include continuing antiplatelet therapy for patients with a baseline indication for it, starting dual antiplatelet therapy for patients with confirmed ACS, and adding prophylactic-dose LMWH for patients on antiplatelet therapy for a previous stroke.

Reconsideration of routine thromboprophylaxis in older adults may be warranted, as the SYMPTOMS trial found no significant difference in the prevention of symptomatic venous thromboembolism when comparing low-molecular-weight heparin with a placebo. Further research is needed to validate these results and determine the best strategies for VTE prevention in this demographic.

A 37-year-old man presented with persistent swelling, limited range of motion, and loss of hand dexterity in both hands. He had a history of IV drug use, including opiates and methamphetamine. The examination showed diffuse swelling without joint inflammation. Lab tests were normal, and imaging revealed soft-tissue swelling. The diagnosis was puffy hand syndrome, a common complication of IV drug use. Treatment options are mainly symptomatic, including discontinuation of IV drug use and the use of low-stretch bandages and compression gloves. Puffy hand syndrome, often unrecognized by general practitioners, should be considered in patients with swelling and limited hand function who have a history of IV drug use. The syndrome involves progressive fibrosis of subcutaneous tissues due to repeated injection-induced vascular and dermal sclerosis. Diagnosis is based on clinical presentation, history, and evaluation ruling out other conditions. Treatment focuses on symptomatic relief and cessation of IV drug use.