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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