Anticoagulation at intermediate AF risk gets its trial, and a lower blood pressure target in sick children

The edition in brief

In SINGLE-AF, 1,803 patients in South Korea with atrial fibrillation and a CHA2DS2-VASc score of 1 in men or 2 in women were randomised to a direct oral anticoagulant or no anticoagulation. At 24 months the composite of stroke, embolism, major bleeding or cardiovascular death occurred in 0.5% v 1.5% (HR 0.31, 95% CI 0.10 to 0.94), with similar major bleeding; event numbers were small. In the PRESSURE trial across 23 paediatric intensive care units, a permissive mean arterial pressure target above the fifth centile for age reduced vasopressor exposure by 37.5% without changing the composite of death and ventilation at 30 days, and kidney replacement and adverse events did not differ. A population study of 2.3 million older adults in Ontario ranked 24 prescribing cascades worth targeting, led by iron to laxative, statin to analgesic and cholinesterase inhibitor to sleep agent. A BMJ network meta-analysis of 124 trials found brisk walking or jogging and combined aerobic-resistance exercise improved bone density in adults over 40, with benefit around 2–3 hours of brisk walking a week; certainty was low to moderate. The pearl covers bleeding risk scores as a prompt to fix risk factors rather than a reason to withhold anticoagulation.