The Pulse - June 2025

In this monthly edition, we examine 2 practice changing studies from June 2025.

1. Stay on TASC: Therapeutic Anticoagulation in Acute Chest Syndrome

   In the TASC trial, 172 adults with sickle cell disease and acute chest syndrome (ACS) were randomized to therapeutic or prophylactic anticoagulation with tinzaparin. Therapeutic anticoagulation led to faster clinical resolution than prophylactic dosing (median 4.8 vs. 6.1 days). Patients also required fewer opioids (124 vs. 219 MME), suggesting reduced symptom burden. Despite the higher anticoagulant intensity, no major bleeding events were reported. Outcomes such as ICU admission, length of stay, and mortality were similar between groups. While promising, these findings come from a relatively stable cohort—only ~30% were hypoxemic—so full-dose anticoagulation may warrant a hematology consult, especially in more complex or severe presentations. Still, for ACS with suspected microthrombotic drivers, this may be a case where going "therapeutic" pays off. Mekontso Dessap A et al. Am J Respir Crit Care Med 2025 Apr. 

   Link: https://doi.org/10.1164/rccm.202409-1727oc

   Study Type: double blinded RCT of 172 patients with sickle cell in 12 French hospitals diagnosed with Acute Chest syndrome but no initial thrombosis.

2. Contrast-Induced Panic: A Thing We Do for No Reason

   In a new installment of Things We Do For No Reason, the long-feared link between iodinated IV contrast (ICM) and kidney injury is put under the microscope—and found wanting. First, a robust body of modern, controlled studies shows that ICM is associated with, but does not cause, worsening renal function in most patients, especially those with eGFR ≥30 mL/min/1.73 m². Second, the pathophysiologic basis of so-called contrast-induced AKI remains poorly defined, with no consistent biomarker or histologic evidence of nephron injury. Third, even in cases where creatinine rises post-contrast, downstream consequences like dialysis or sustained CKD progression are rare. And fourth, avoiding necessary contrast studies due to outdated fears—“renalism”—may delay diagnosis and lead to worse outcomes. The takeaway: fear of contrast has outpaced the data, and in many cases, doing the scan is safer than skipping it. Coleman et al, J Hosp Med 2025 Apr. 

   https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.70063

   Study Type: Things We Do For No Reason summary of several RCTs and meta-analysis

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