The edition · Internal Medicine
Over 80 with atrial fibrillation: age alone is a poor reason to stop anticoagulation
A 45,000-patient cohort links continued anticoagulation in the over-80s to lower mortality, at the cost of more GI bleeding. Also today: getting patients admitted with alcohol use disorder to follow-up, how far the incretin drugs now go, and obesity and early cancer.
The edition in brief
In a US cohort of 45,305 adults aged 80 or older with atrial fibrillation, continued anticoagulation was associated with lower one-year mortality than never being anticoagulated (8.7% vs 17.7%; time-varying HR 0.75), with more gastrointestinal bleeding but similar intracranial haemorrhage (1.3–1.6%); the design is observational and mortality converged by five years. A systematic review of hospital-based interventions to link patients admitted with alcohol use disorder to outpatient care found 17 studies; 8 of 21 interventions improved linkage, usually those combining behavioural support and care coordination with medication or social support, at low certainty. An updated review of 38 trials in adults without diabetes found placebo-subtracted weight loss up to 19.0% with tirzepatide and 14.8% with subcutaneous semaglutide, with GI effects in 76% and discontinuation for side effects in 10.7%. A Korean cohort of 6.3 million adults aged 20–39 linked obesity by Asian criteria to higher ten-year cancer incidence (2.62% vs 1.84% for class II obesity), most for thyroid, endometrial and ovarian cancer.
Linking inpatients with alcohol use disorder to follow-up: what has worked, and how little is known
Before discharging a patient with alcohol use disorder, consider starting medication and book the follow-up yourself.
Incretin drugs for weight in adults without diabetes: the current numbers in one place
Ask about GLP-1-based drugs on every admission, and consider them when a patient presents with vomiting or poor intake.
Obesity by Asian criteria linked to higher early-onset cancer in 6.3 million young Korean adults
Measure waist as well as BMI in young adults, using Asian thresholds; obesity at this age was linked to modestly higher early cancer risk.
Before ordering tomorrow's bloods, ask what result would change the plan
Review every standing lab order on the ward round and stop those whose result would not change management.
Anticoagulation in atrial fibrillation over 80 was linked to lower mortality despite more GI bleeding
In people over 80 with atrial fibrillation, keep anticoagulation going unless there is a specific reason to stop; manage GI bleeding risk, not age.
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