The Pulse - April 2025

In this monthly edition, we examine 3 practice changing studies from April 2025.

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1. Blood Feud: Why the Little Dose Might Win Big in Cancer-Related Clots

   When it comes to long-term anticoagulation in cancer patients, less can indeed be more. This trial showed that low-intensity apixaban (2.5 mg) held its own against the full dose (5 mg) for preventing recurrent VTE—and bled less while doing it. With only a 0.7% difference in recurrence and fewer bleeding events (12.1% vs. 15.6%), the low-dose crew punched above its weight. The trial's message? You don’t have to hit hard to win the fight—sometimes finesse does the trick. Expect practice guidelines to take note and lighten up. Mahe I et al. N Engl J Med 2025 Mar.

   Study Type: double-blind, noninferiority RCTs of 1766 patients with cancer and VTE (DVT or PE) who had already completed 6 months of regular dose AC were then randomized to low dose or regular dose apixaban

   Link: https://doi.org/10.1056/NEJMoa2416112

2. The Tube of Truth—or Tumors?

   

   CT scans are often life-saving, but they’re also quietly increasing cancer risk, according to an updated estimate. With 93 million scans in 2023 alone, researchers say these glowing snapshots could spark over 102,000 future cancers, more than doubling the scary stats from 2009 (causing 5% of new cancer diagnoses vs 2% in 2009). Lung, colon, and thyroid cancers are especially in the CT spotlight, with kids under 1 and adults in their 50s drawing the shortest straws. The bottom line? That helpful scan may be a Trojan horse. When possible, consider alternatives like MRI or ultrasound. Smith-Bindman R et al. JAMA Intern Med 2025 Apr.

   Study Type: risk model study based on the National Cancer Institute’s Radiation Risk Assessment Tool (RadRAT) and using data from UCSF International CT Dose Registry

   Link: https://doi.org/10.1001/jamainternmed.2025.0505 

3. Drain, No Gain: Thoracentesis Comes Up Dry in Heart Failure Trial

   Turns out poking holes doesn’t always help—at least not when it comes to heart failure and pleural effusions. A multicenter Danish RCT found no added benefit from upfront thoracentesis when compared with goal-directed medical therapy alone—no difference in mortality, time outside the hospital, length of stay, or symptom scores. The trial focused on patients with moderate effusions (<⅔ hemithorax) and excluded those with other likely causes for fluid buildup. The data support a "hold the pigtail" approach in typical HF patients, keeping invasive maneuvers in reserve unless the clinical picture demands it. Glargaard S et al. Circulation 2025 Apr.

   Study Type: multicenter, unblinded, randomized controlled trial of 135 patients with acute heart failure, left ventricular ejection fraction ≤45% (median 25%), and non-negligible pleural effusion (very large effusions, >⅔ hemithorax, were excluded)

   Link: https://doi.org/10.1161/CIRCULATIONAHA.124.073521 

Ever wondered whether that steroid you ordered can really explain the new leukocytosis or if you should be looking for an occult infection? 

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