Top Clinical Updates
Carotid revascularisation did not improve cognition in asymptomatic stenosis, even with poor brain perfusion
A CREST-2 substudy removes a common reason for referral; an oral pyruvate kinase activator reduced transfusion need in thalassaemia; and older recipients gain less from expanded-criteria kidneys.
Complete revascularisation after STEMI guided by angiography-derived physiology cut major events by 38%
AIR-STEMI favours functional angiography over the eye for non-culprit lesions; a Swedish nationwide trial finds no ischaemic advantage for prasugrel over ticagrelor; blinatumomab can replace two cycles of toxic chemotherapy in high-risk childhood leukaemia.
One week of antibiotics after surgery for bone infection was as good as four
SOLARIO shows local antibiotic carriers let systemic therapy stop at a week; radiotherapy halved recurrence after complete removal of atypical meningioma; and three negative trials — CT angiography after ruled-out MI, carotid revascularisation for cognition and a bacterial lysate for preschool wheeze — tell clinicians what to stop doing.
After high-risk adenomas, first surveillance colonoscopy can wait five years
EPoS II found a 5-year first surveillance was non-inferior to 3 years for colorectal cancer in 10,799 patients. Also: catheter-directed thrombolysis in intermediate-high-risk PE, antidepressants and the QT interval, and two negative trials — FMT for IBS and maternal egg and peanut diets.
Oral menopausal oestrogen raised clot risk at every dose; transdermal did not, in 40,000 Danish cases
A nationwide BMJ case-control study gives the route of HRT a number. Also: SGLT2 inhibitors and GLP-1 agonists protected the kidney only where there was albuminuria, tenecteplase before late basilar thrombectomy added nothing, and 14-day ECG monitoring after unexplained syncope did not reduce further episodes.
Multicancer blood test did not reduce late-stage cancer in NHS-Galleri
The 142,000-person English trial found three annual rounds of a blood-based multicancer test did not lower stage III–IV diagnoses. Also: stopping beta-blockers years after MI, arthrodesis for hallux rigidus, parental B12 and birth defects, and a methaemoglobinaemia outbreak traced to a fuel additive.
Catheter ablation for atrial fibrillation did not beat a sham procedure on quality of life
A double-blind, sham-controlled trial puts a number on how much of ablation's symptom benefit is the procedure itself; plus a tobacco treatment guideline that ranks the drugs, and evidence that imported risk equations misjudge age.
A neuroprotectant that worked, and 24 prescribing cascades worth knowing by name
A Chinese phase 3 trial reports a 13-point absolute gain in full recovery after ischaemic stroke, a Lancet trial settles a long-argued question about liposuction for lipoedema, and a two-million-patient cohort names the drug sequences that most often start a cascade.
A lipid guideline moves to PREVENT and Lp(a), and thalassaemia gets its first oral disease-modifying drug
The VA/DoD update changes how primary-prevention risk is calculated; a phase 3 trial cuts transfusion burden in thalassaemia with a tablet; carotid surgery fails to rescue cognition; and a fifth-dose yellow fever vaccine holds up in toddlers.
The haemoglobin that is 'just normal' is not where mortality is lowest
Half a million adults followed 13.6 years put the lowest mortality 1 to 3 g/dL above the WHO anaemia threshold; perioperative durvalumab improves survival in resectable gastric cancer; and an IL-33 antibody cuts COPD exacerbations irrespective of eosinophils.
Opening a carotid does not open the mind, and an injection beats a daily pill
CREST-2's cognitive results close a long-standing argument about asymptomatic stenosis; two-monthly injectable antiretrovirals outperformed daily tablets in African adolescents; and an orexin agonist restores wakefulness in narcolepsy type 1.
Seven days of antibiotics matches four weeks in bone infection, and surveillance colonoscopy at five years matches three
Two noninferiority trials shorten long-standing regimens; blinatumomab replacing two chemotherapy cycles lifts four-year event-free survival in high-risk childhood leukaemia by 13 percentage points; a maternal high egg and peanut diet does not prevent infant allergy; and head elevation after thrombectomy remains unproven.
AF at intermediate stroke risk: a first randomised trial favours starting a DOAC
SINGLE-AF tests the grey zone of CHA₂DS₂-VASc, STAREE shows statins in over-70s cut cardiovascular events without extending disability-free life, and catheter thrombolysis prevented early collapse in intermediate-high-risk PE.
Stopping beta-blockers years after an uncomplicated MI met non-inferiority
Pooled data from two trials support deprescribing when ejection fraction is preserved. Also: shorter antibiotics for endocarditis at a cost in relapse, KDIGO's new anaemia guideline, iron before cardiac surgery, and ECG monitoring after unexplained syncope.
Catheter ablation for atrial fibrillation beat a sham procedure by 2.6 points, and missed
A double-blind sham-controlled trial finds most of the symptom benefit of ablation was not the ablation. Plus what happened after a caesarean antibiotic trial was published, and a negative immunotherapy trial in early lung cancer.
A neuroprotectant that worked in a 997-patient stroke trial, and the 24 prescribing cascades worth knowing by name
Loberamisal raised the proportion of stroke patients reaching full functional recovery from 56.3% to 69.7% at 90 days - in one country, in a selected population. And a two-million-person cohort names the drug-begets-drug sequences that fill older patients' repeat lists.
An oral drug cuts transfusions in thalassaemia, and physiology beats the eye in STEMI
Mitapivat reduces transfusion burden in transfusion-dependent thalassaemia; liposuction outperforms decongestive therapy for lipoedema pain; fifth-dose yellow fever vaccine holds up in toddlers; and a fuel additive explains a cluster of near-fatal methaemoglobinaemia.
Cellulitis without the bloods, rheumatoid arthritis to target, and a pregnancy history that belongs in the risk score
Two reviews that settle common decisions, a phase 3 trial that displaces tacrolimus in membranous nephropathy, and the argument for treating an obstetric history as cardiovascular data.
Tuberculosis and lung nodules back to first principles, and immunotherapy moves into resectable gastric cancer
Two clinical reviews worth an hour of anyone's time, a pig kidney that kept a patient off dialysis for 271 days, and a phase 3 survival result that changes the perioperative standard.
A biologic for COPD that does not ask about eosinophils
Two replicate phase 3 trials cut exacerbations by about 30% with no eosinophil entry criterion; a masked trial with sham incisions finds robotic knee replacement no better and more expensive; and half a million adults suggest the mortality floor for haemoglobin sits above the anaemia threshold, not at it.
Replacing what narcolepsy lost, and replacing induction chemotherapy in AML
An oral orexin agonist restores wakefulness to near-normal in two phase 3 trials; azacitidine-venetoclax beats induction chemotherapy in patients fit for it; a bacterial lysate fails to prevent childhood wheeze; and 17 African countries show what acute heart failure looks like where care arrives late.
A statin in the over-70s prevented heart attacks but did not extend disability-free life
STAREE randomised nearly 10,000 community-dwelling older adults to atorvastatin or placebo and split its two primary endpoints, an ECG algorithm flags treatable cardiac amyloidosis before echocardiography, and a text message beats a portal message for nobody in particular.
A ruled-out troponin still carries risk, and a CHA2DS2-VASc of 1 is not nothing
Routine CT coronary angiography after a ruled-out chest pain changed nothing over three years; physiotherapists ran the musculoskeletal side of five emergency departments an hour faster and cheaper; and a Korean trial finally randomises the anticoagulation decision everyone guesses at.
Stopping antibiotics early in endocarditis buys freedom at the cost of relapse
POET II shortened antibiotic therapy for left-sided infective endocarditis in stable patients and met its safety endpoint — but relapse rose from 1.6% to 5.1%. Plus: beta-blockers can be stopped years after a heart attack, and saline holds its ground in paediatric septic shock.
Catheter ablation for atrial fibrillation fails against a sham procedure
A double-blind sham-controlled trial finds no quality-of-life advantage for AF ablation, catheter-directed thrombolysis cuts early deterioration in intermediate-high-risk pulmonary embolism, and two weeks of ECG monitoring after syncope changes nothing.