Last Week in Medicine

Extra, extra, read all about it! We have two "NEWS" studies to talk about in this episode (bad pun).  Does catheter directed thrombolysis improve outcomes in acute intermediate risk PE? Does adding procalcitonin to NEWS2 screening of ED patients really reduce mortality in patients with suspected sepsis?? The results may surprise you. Biostatistics ninja and critical care physician Dr. Brian Locke joins us to discuss! 

Ultrasound Facilitated Catheter Directed Fibrinolysis for Acute PE (HI-PEITHO)

NEWS2 Plus Procalcitonin for Sepsis Screening (PRONTO)

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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)

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The ACC/AHA published new guidelines for managing acute PE on February 19, 2026. Today I'm joined by Dr. Scott Woller, MD, MACP, FCCP, who was co-chair of the American College of Chest Physicians Clinical Practice Guideline for antithrombotic therapy for venous thromboembolism, last updated in 2021. He also served as co-chair for the peer review committee for these new guidelines, and has lots of great insights into how to use them in clinical practice and research. 

2026 ACC/AHA Guidelines for Diagnosis and Managing Acute PE

Some highlights from the guidelines:

• New categories of PE: 
  • A: asymptomatic
  • B: symptomatic, low risk
  • C: symptomatic, high risk
  • D: incipient shock
  • E: cardiogenic shock
• PE response teams (PERTs) are ascendant
• Use enoxaparin instead of heparin drip!
• Advanced therapies for category D and E
• Half dose DOACs for extended treatment
• Shared decision making for clots provoked by minor risk factors
• Patients with persistent symptoms need evaluation for CTEPD

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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 Cystinosis

Donate to the Cystinosis Research Foundation

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In this episode, Dr. Austin Rupp and I try to answer the following questions:

• Should patients with provoked VTE be offered long term anticoagulation if they have persistent risk factors, like obesity? 
• Does coffee make atrial fibrillation worse (or better??)? 
• Is age-adjusted d-dimer safe to use in DVT? 
• Should we prescribe beta blockers after acute MI if the EF is normal?
• Does fish oil improve cardiovascular outcomes in patients on dialysis?
• What's the best approach for dialysis in patients with acute kidney injury?

The articles:

Extended Apixaban for Provoked VTE (HI-PRO)

Coffee and Atrial Fibrillation (DECAF)

Age-Adjusted D-dimer for DVT (ADJUST-DVT)

Beta-blockers after MI with normal EF

Fish Oil in Dialysis Patients (PISCES)

Conservative Dialysis in AKI (LIBERATE-D)

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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 Guidelines

Apixaban vs Rivaroxaban vs Warfarin 

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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 Pneumonia

Intensive BP Control in Patients with Diabetes (BPROAD)

Lorundrostat for Uncontrolled Hypertension (ADVANCE-HTN)

Reduced Dose Apixaban for Cancer Associated Thrombosis (API-CAT)

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For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. 

Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more!

Half Dose DOAC for Long Term VTE Prevention (RENOVE)

Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis)

GPT-4 Assistance for Physician Performance

Optimal Vasopressin Initiation for Septic Shock (OVISS)

DOACs for A fib after ICH (PRESTIGE-AF)

High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE)

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We're back, after a brief hiatus! 

Today we talk about duration of therapy for bacteremia, Factor XI inhibition for atrial fibrillation, whether to stop ACEi or ARB before elective surgery, and whether GLP-1 agonists are beneficial in heart failure with preserved ejection fraction. 

Go to minute 7:30 to skip the banter. 

7 vs 14 Days of Antibiotics for Bacteremia (BALANCE)

Abelacimab vs Rivaroxaban for Atrial Fibrillation (AZALEA-TIMI-71)

Asenduxian vs Apixaban for Atrial Fibrillation (OCEANIC-AF)

ACEi or ARB Discontinuation Before Surgery (STOP or NOT)

Tirzepatide for HFpEF and Obesity (SUMMIT)

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It's been a long time, but we are back!

Apologies on the audio quality from Dr. Jenkins. Apparently he was recording from inside a cardboard box.

Today we talk about important, practice changing studies in internal medicine from the last several months. What's the best anticoagulant in patients with cirrhosis and atrial fibrillation? Why do doctors use so much unfractionated heparin for acute PE? Should we still be using beta blockers in patients with acute MI? Does finerenone improve outcomes in HFpEF? Is continuous infusion of antibiotics better than intermittent? And will the cefepime vs piperacillin-tazobactam battle ever end?

Apixaban, Rivaroxaban and Warfarin in Cirrhosis for AF

Anticoagulation Trends for Acute PE

Beta Blockers for Acute MI with Normal EF

Finerenone for HFpEF FINEARTS-HF

Continuous vs Intermittent Infusion of Beta-Lactams BLING III

Prolonged vs Intermittent Infusions of Beta-Lactams Meta-analysis

Piperacillin-Tazobactam vs Cefepime for Sepsis

Recurrent SBP in Patients on Secondary Prophylaxis

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