The Pulse - February 2026

Greetings Readers! In this monthly edition, we examine 2 practice changing studies.

When is it best to de-escalate antibiotics in community-onset sepsis?

Studies exploring this question and more were covered this month in Premium Pulse.

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1. ACLS 2025: Same Algorithm, Sharper Edges

   The 2025 update to Advanced Cardiac Life Support from the American Heart Association offers refinement rather than revolution—no new drugs to memorize, but several practical pivots to note. In opioid-associated arrest, CPR should not wait on naloxone; hands first, antidote second. Manual compressions remain the default for most out-of-hospital arrests, IV access is preferred over IO for medication delivery (with IO as backup), and synchronized cardioversion for atrial fibrillation/flutter now starts at 200 J biphasic. The guidelines advise against vector change or double sequential defibrillation in refractory VF, recommend immediate defibrillation for polymorphic VT, and endorse experienced POCUS use only if it doesn’t interrupt compressions. Post-ROSC care emphasizes targeted temperature management at 36°C for at least 36 hours, while cognitive aids are encouraged for clinicians (not lay rescuers), and CPR/AED training is endorsed even for adolescents—because the chain of survival may start earlier than we think.

   Link

2. Time to ADAPT: Simplifying Anticoagulation after Drug-Eluting Stents in Afib

   In this multicenter, randomized, open-label noninferiority trial from South Korea, investigators compared DOAC monotherapy with DOAC + clopidogrel in patients with atrial fibrillation at least one year after drug-eluting stent (DES) placement. The primary composite endpoint—death, MI, stent thrombosis, stroke/systemic embolism, or clinically significant bleeding—occurred less frequently with monotherapy (9.6% vs 17.2%), meeting criteria for noninferiority and even demonstrating superiority. The difference was driven largely by a substantial reduction in bleeding, with major or clinically relevant nonmajor bleeding nearly three times lower in the monotherapy group. Importantly, ischemic protection was not sacrificed in the process. In short, for stable AF patients beyond the one-year stent mark, dropping the antiplatelet appears less like a gamble and more like good housekeeping. Lee S et al. NEJM 2026 Feb. 

   Study Type: multi-center, South Korean, open-label, noninferiority RCT of 960 patients with atrial fibrillation who had also undergone DES placement at least 1 year prior.

   Link 

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