Dr RR Baliga's "Got Knowledge Doc" Podkast

🫀 Personalizing DAPT: When "One Size Fits All" Fails 🕊️💊

The HOST-BR trial in The Lancet offers an important clinical lesson:

Bleeding risk should guide antiplatelet duration after PCI — not habit, not inertia.

🔍 Key insight

• In ARC-HBR patients, 1-month DAPT was not non-inferior to 3 months

• In non-HBR patients, 3-month DAPT was non-inferior to 12 months and reduced bleeding

🧠 Clinical takeaway

➡️ Ultra-short (1-mo) DAPT is risky in high-bleeding-risk patients

➡️ Short (3-mo) DAPT is safe and bleeding-sparing in lower-risk patients

🔧 Precision medicine in action:

Stratify → Tailor → Protect

📎 HOST-BR | The Lancet (2025)

A beautiful reminder that medicine advances when we match therapy to physiology — not the other way around.

🌟 "Do no harm" is evolving… now it means do no unnecessary bleeding.

#Cardiology #InterventionalCardiology #PrecisionMedicine #DAPT #PCI #BleedingRisk #Lancet

🚨 New Pharmacotherapy for Obstructive Sleep Apnoea 🌙💊

In a landmark Phase 2 trial published in The Lancet, sultiame— a carbonic anhydrase inhibitor—showed dose-dependent reduction in AHI and improved nocturnal oxygenation in adults with moderate–severe OSA.

💡 Key insights:

• 298 participants across 5 European countries

• 200 mg daily delivered the best efficacy-to-tolerability balance

• Benefits most notable in sleepy phenotypes (ESS >10)

• Mild, dose-related paraesthesia most common AE

🔬 A promising step toward precision sleep medicine and pharmacologic options for patients who struggle with CPAP.

🌬️ Better breathing by night → brighter cognition by day.

📖 Lancet, 2025 — FLOW Study (Randerath et al.)

📢 New Study Alert 🩺💊 In JAMA Internal Medicine, a national analysis reveals that using the PREVENT risk calculator (vs Pooled Cohort Equations) dramatically reduces the number of U.S. adults aged 40–59 eligible for aspirin in primary prevention of cardiovascular disease. Among 7.6 million current aspirin users, >96% wouldn't qualify by PREVENT 🤯. Time to rethink our calculators and consider deprescribing where net benefit is questionable.

📰 Read more: https://jamanetwork.com/journals/jamainternmed/fullarticle/10.1001/jamainternmed.2025.5049

🧠 TACSI Trial in NEJM (Sep 2025) challenges the status quo on dual antiplatelet therapy after CABG for ACS!

👨‍⚕️ 2201 patients across 5 Nordic countries

💊 Ticagrelor + Aspirin ≠ better outcomes vs Aspirin alone

📉 No reduction in death, MI, stroke, or revascularization

🩸 But bleeding (4.9% vs 2.0%) & dyspnea (18.2% vs 6.4%) increased

📚 Guidelines may need rethinking.

📖 Jeppsson A et al. N Engl J Med. 2025; DOI: 10.1056/NEJMoa2508026

#TACSI #Cardiology #CABG #DAPT #ACS #NEJM #PrecisionMedicine #RCT #BleedingRisk #ClinicalTrials

🧪 NEO-MINDSET Trial 🇧🇷 published in NEJM asks: Can we safely drop aspirin early after PCI in acute coronary syndromes (ACS)?

💊 Monotherapy with ticagrelor/prasugrel reduced bleeding 🩸 but increased early ischemic events 💥 vs dual antiplatelet therapy (DAPT).

❗ Noninferiority for major adverse cardiovascular events was not met.

🔍 DAPT still stands tall in early post-PCI ACS care.

Kudos to the Brazilian team for a landmark RCT!

📖 NEJM 2025 | doi: 10.1056/NEJMoa2507980

#NEOMINDSET #PCI #ACS #cardiotwitter #RCT #DAPT #P2Y12 #Bleeding #NEJM #PrecisionMedicine #InterventionalCardiology

🚨 New in NEJM — The ALASCCA Trial 🧬

Low-dose aspirin (160 mg/day) reduced colorectal cancer recurrence in patients with PIK3CA, PIK3R1, or PTEN mutations 🎯

✅ 3-year recurrence: 7.7% (aspirin) vs 14–17% (placebo)

✅ Group A HR: 0.49 | Group B HR: 0.42

✅ NNT as low as 6 in stage III rectal cancer 💥

⚠️ Slight increase in adverse events

🧠 Editorial calls it a new standard of care:

🔬 Genotype early + 💊 Start aspirin early = 📉 Lower recurrence

📖 Read both the trial and editorial in NEJM, Sept 2025

#ColorectalCancer #PrecisionOncology #Aspirin #PIK3CA #NEJM #OncologyTrials #Genomics #AdjuvantTherapy #ALASCCA #ClinicalTrials

💡 TARGET-FIRST trial (NEJM, Aug 2025) shows that in low-risk AMI patients post-PCI with complete revascularization, stopping aspirin after 1 month and continuing P2Y12 monotherapy is noninferior to dual antiplatelet therapy—with 54% fewer bleeding events 🩸🛑💊

⚖️ A modern, patient-tailored antiplatelet strategy—backed by potent P2Y12 inhibitors and smart selection—might just be the new norm in contemporary cardiology 🫀

📘 New England Journal of Medicine

🔗 https://doi.org/10.1056/NEJMoa2508808

#Cardiology #DAPT #PrecisionMedicine #NEJM #TARGETFIRST

💡 "Cogito, ergo sum" — I think, therefore I am. René Descartes laid the foundation of modern Western philosophy and scientific reasoning, linking algebra to geometry, and mind to body.

🧠📐 His legacy reminds healthcare professionals to unite reason with compassion — science with soul. ❤️⚕️

💊🫀 Aspirin in the Crosshairs?

The AQUATIC Trial (NEJM, Aug 2025) raises sharp questions on dual-pathway therapy in chronic coronary syndrome (CCS) patients already on long-term anticoagulation.

📉 Adding aspirin led to:

• ↑ Ischemic events (HR 1.53; P=0.02)

• ↑ Mortality (HR 1.72; P=0.01)

• ↑ Major bleeding (HR 3.35; P)

🧠💥 Could lead poisoning have helped shape human evolution? A bold new hypothesis suggests that Homo sapiens may have survived while Neanderthals and Denisovans vanished—thanks to genetic defenses against environmental lead. 🧬

By analyzing fossil teeth 🦷 and testing brain organoids 🧪, researchers found that ancient lead exposure disrupted key language-related genes (like FOXP2)—but not in modern human variants.

👣 Sometimes, evolution turns adversity into advantage.

📖 Published in Science (Oct 2025): "Did lead poisoning help drive human evolution?"

🔗 doi:10.1126/science.aed1022

#Evolution #Neuroscience #Anthropology #Genetics #FOXP2 #NOVA1 #LeadPoisoning #Paleoanthropology #Science 🦴🧬