Last Week in Medicine

We are back with a landmark trial -- COBRRA was finally published! Apixaban wins again, but is rivaroxaban done for good?? Also, is left atrial appendage occlusion safer than oral anticoagulation in patients with a high risk of stroke and a high risk of bleeding? Check it out!Apixaban vs Rivaroxaban for Acute VTE (COBRRA)Left Atrial Appendage Closure vs Medical Management (CLOSURE-AF)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Scott Woller, research professor and thrombosis expert who helped shape the 2026 ACC/AHA pulmonary embolism guidelines. He describes a new A–E PE classification, the rise of PE response teams, preference for enoxaparin over heparin drip, expanded advanced catheter and thrombectomy options, and guidance on half-dose DOACs for extended therapy.

In this episode I'm joined by senior author Dr. Stephanie Cherqui to talk about her recent publication in the New England Journal of Medicine on gene therapy for cystinosis. This is a very personal episode for me, because two of my children have cystinosis. The article is linked below. Thanks for listening!Hematopoietic Stem Cell Gene Therapy for CystinosisDonate to the Cystinosis Research FoundationMusic from #Uppbeat (free for Creators!):https://uppbeat.io/t/sky-toes/industry-leadersLicense code: EBP4TMGNANGDJM1RMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

They debate extended apixaban for provoked VTE and the tradeoff between recurrence reduction and bleeding. They quiz whether coffee affects atrial fibrillation recurrence after cardioversion. They cover age-adjusted D-dimer use to reduce unnecessary imaging. They reassess routine beta blockers after MI with normal ejection fraction. They weigh fish oil benefits in dialysis patients and conservative dialysis strategies for AKI.

Today we do a round-up of some of the recent semaglutide trials. Does semaglutide ever miss? But what about tirzepatide, which causes even more weight loss?We also review two new critical care trials, FLUID and the UK-ROX, new platelet transfusion guidelines, and a new retrospective study of apixaban vs rivaroxaban vs warfarin. Oral Semaglutide for Diabetes with Cardiovascular Disease or CKD (SOUL)Semaglutide for Peripheral Artery Disease (STRIDE)Semaglutide for MASH (ESSENCE)Semaglutide vs Tirzepatide for Obesity (SURMOUNT-5)Normal Saline vs Lactated Ringers (FLUID)Conservative Oxygen Targets in Mechanically Ventilated Patients (UK-ROX)Platelet Transfusion GuidelinesApixaban vs Rivaroxaban vs Warfarin Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

What do you do when most trials suggest benefit for an intervention, but then a new trial suggests harm? We thought steroids in pneumonia was a settled question, but REMAP-CAP had other plans!We also review a new RCT for BP targets in patients with hypertension and diabetes, a new aldosterone synthase inhibitor for hypertension, and reduced dose apixaban for cancer-associated thrombosis. Hydrocortisone for Severe CAP (REMAP-CAP)Predicting Benefit of Corticosteroids in PneumoniaIntensive BP Control in Patients with Diabetes (BPROAD)Lorundrostat for Uncontrolled Hypertension (ADVANCE-HTN)Reduced Dose Apixaban for Cancer Associated Thrombosis (API-CAT)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

Join Dr. Brian Locke, an intensivist at Intermountain with a knack for statistics, as he dives into cutting-edge medical research. He discusses the effectiveness of half-dose DOACs for VTE prevention, weighing bleeding risks and treatment options. The conversation heats up around using biomarkers to guide antibiotic durations for sepsis, alongside the challenges and promises of AI, particularly GPT-4, in enhancing physician productivity. Additionally, Locke examines critical decisions around anticoagulation in atrial fibrillation and compares high-flow nasal cannula versus non-invasive ventilation for respiratory failure.

Following a refreshing break, the hosts dive into critical medical discussions. They explore the BALANCE trial, weighing the effectiveness of seven versus fourteen days of antibiotics for bacteremia, revealing insights on antimicrobial resistance. The conversation shifts to Factor XI inhibitors, highlighting new anticoagulants like abilacimab for atrial fibrillation. Lastly, they discuss GLP-1 agonists, specifically terzepatide, and their promising results in treating heart failure with preserved ejection fraction and obesity.

Dr. Jenkins, an insightful contributor in internal medicine, dives into groundbreaking studies that could change clinical practice. He discusses the best anticoagulants for patients with cirrhosis and atrial fibrillation, pondering the roles of apixaban and rivaroxaban. The conversation pivots to the efficacy of beta blockers post-myocardial infarction, questioning traditional protocols. They also explore antibiotic delivery methods in sepsis and compare cefepime against piperacillin-tazobactam, raising concerns about efficacy and safety in treatment.

Dr. Brian Locke, a recently graduated pulmonary-critical care fellow, discusses interesting topics such as the potential of metformin in reducing long COVID, platelet transfusion before central line placement, the impact of DOACs versus LMWH in cancer-associated thrombosis, and the debate on early versus late anticoagulation after stroke with atrial fibrillation.