The Curbsiders Internal Medicine Podcast #445 DIGEST-Hotcakes: Preventive PCI, Andexanet Alfa for ICH, Aspirin for Fatty Liver, Naltrexone in Cirrhosis, Pivmecillinam for UTI, Cefepime vs Pip-Tazo, MDRO Decolonization, Microplastics and MACE, Pax-NO-vid
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Jun 24, 2024 
Experts discuss topics such as preventive PCI, andexanet alfa for ICH, aspirin for fatty liver, naltrexone in cirrhosis, pivmecillinam for UTI, cefepime vs pip-tazo, MDRO decolonization, and microplastics and MACE in a fun and informative hotcakes-style podcast.
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Preventive PCI Showed Small Composite Benefit Driven By Revascularization
- Preventive PCI reduced the composite of cardiac death, MI, or target-vessel revascularization by ~3% at 2 years in the PREVENT trial.
- Benefit was driven mainly by fewer revascularizations, trial was open-label with few early events and possible bias from differential care.
Andexanet Alfa Improves Hemostasis But Increases Thrombosis
- Andexanet alfa improved a 12-hour composite hemostatic endpoint by 13% in DOAC-associated ICH but did not change 30-day mortality or neurologic outcomes.
- Treatment raised thrombotic events (~5% absolute increase, mainly ischemic strokes), and trial had changes that could bias positive primary outcome.
Aspirin Reduced Hepatic Fat In Small Phase 2 MASLD Trial
- Low‑dose aspirin (81 mg) reduced hepatic fat by MRI at 6 months in a small phase 2 MASLD trial (mean −6.6% vs +3.6% in placebo).
- Study had 80 participants, mean age 48, no cirrhosis; outcome is imaging surrogate needing larger trials with patient‑centered endpoints.