Deep learning model may help detect type 1 MI and revascularization need from ECG patterns, reveals research

A new study published in the European Heart Journal showed that IL-Using electrocardiogram (ECG) data, a new artificial intelligence (AI)-powered tool may identify type 1 myocardial infarction (MI) more accurately at a level comparable to that of a high-sensitivity troponin T (hs-TnT) assay.

Inconclusive electrocardiogram (ECG) or biomarker data can make it difficult to identify individuals with acute coronary syndrome who need coronary revascularization. Antonius Büscher and colleagues created a deep learning model to identify ECG patterns linked to the risk of revascularization in order to direct additional evaluation and lower diagnostic ambiguity.

A convolutional neural network model was evaluated using a different test cohort (n=35,995), trained on 1,44,691 ED visits from a US cohort (60±19 years; 53% female; 0.6% revascularization), and compared to cardiac troponin T (TnT) and clinician ECG interpretation.

The results of 18,673 hospitalizations from Europe (55±21 years; 49% female; 1.5% revascularization; 1% type 1 MI) were externally validated for revascularization and type 1 MI. Area under the receiver operating characteristic curve (AUROC) served as the main performance indicator.

The model outperformed both traditional cardiac TnT (AUROC 0.71) and physician ECG interpretation in the test group, achieving an AUROC of 0.91. ECG model AUROC was 0.81 for revascularization and 0.85 for type 1 MI in the external validation cohort, while it was 0.67 and 0.74 for clinician interpretation and 0.85 and 0.87 for high-sensitivity (hs)-TnT, respectively. When compared to hs-TnT, the ECG model showed a lower sensitivity but a greater specificity.

The algorithm performed better than traditional hs-TnT testing and physicians’ interpretation of the ECG in determining which individuals in the test population needed revascularization. Similar outcomes were obtained in the external validation cohort, where the ECG-AI model outperformed doctors in terms of interpretation but fell short of hs-TnT’s predictive capabilities.

Overall, nearly 2,00,000 ECGs from two worldwide cohorts of patients with NSTE ACS who presented to the emergency department (ED) were used to train the deep-learning model. The findings imply that doctors may eventually get AI assistance when transferring suitable patients from the ED to the cath lab.

Reference:

Büscher, A., Plagwitz, L., Yildirim, K., Brix, T. J., Neuhaus, P., Bickmann, L., Menke, A. F., van Almsick, V. F., Pavenstädt, H., Kümpers, P., Heider, D., Varghese, J., & Eckardt, L. (2025). Deep learning electrocardiogram model for risk stratification of coronary revascularization need in the emergency department. European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf254

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Colorectal cancer linked with increased risk of cardiovascular mortality, reveals research

People diagnosed with colorectal cancer are significantly more likely to die of cardiovascular causes than the general population, especially in the first two years after their cancer diagnosis and in people younger than 50, according to a study being presented at the American College of Cardiology’s Annual Scientific Session (ACC.25).

With colorectal cancer on the rise in the United States, the study is the first to track rates of cardiovascular mortality and assess how risk changes over time. While the reasons for the linkage are not yet known, researchers say the findings point to a need for increased attention to heart health during cancer treatment, particularly among people who are Black, male or younger than 50 years old at the time of their colorectal cancer diagnosis

“Based on our findings, the two-year period after a colorectal cancer diagnosis is a critical period when patients need aggressive care to improve cardiovascular outcomes,” said Ahsan Ayaz, MD, an internal medicine resident at Montefiore St. Luke’s Cornwall Hospital in Newburgh, New York, and a member of the research team. “For example, there should be an aggressive approach to control cardiovascular risk factors and comorbidities like diabetes and hypertension. There is also a need for coordination between oncology teams and primary care teams, because most of those risk factors are managed by primary care providers.”

Heart disease is the leading cause of death worldwide and many studies have shown that people with cancer see an increased risk of cardiovascular problems. A 2022 JACC study found that cancer survivors had a 37% increased risk of cardiovascular disease. However, the relationship between cardiovascular mortality and colorectal cancer specifically has not been well studied.

Researchers used data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database to analyze outcomes among more than 630,000 U.S. adults diagnosed with colorectal cancer between 2000 and 2021. The study defined cardiovascular mortality as any deaths attributed to heart diseases, hypertension, strokes and other cerebrovascular diseases, a buildup of plaque in the arteries (atherosclerosis) or a tear or aneurysm in the aorta.

The results showed that people with colorectal cancer were overall 16% more likely to die of cardiovascular causes than people without colorectal cancer. The risk was highest in the first two years after a colorectal cancer diagnosis, with patients facing a 45% increased risk during this period. The elevated risk was especially pronounced among people younger than 50 years of age, who were 2.4 times more likely to die of cardiovascular causes than people in the same age group who did not have colorectal cancer.

Black patients with colorectal cancer faced a 74% increased risk compared with the general population, while males faced a 55% increased risk. Ayaz said that the disparities observed in the study could stem from multiple factors, such as differences in socioeconomic status, geographic location or access to care, and warrant further study and attention.

The heightened risk of cardiovascular death could stem from side effects of cancer treatment, from the cancer itself and the inflammatory processes it causes, or from some other cause or combination of causes, researchers said.

“For therapies that are newer, there is not a lot of data on the side effects and toxicities, but evidence is emerging that they cause cardiovascular toxicity,” Ayaz said. “It is important to identify these problems promptly and take steps to mitigate them.”

The researchers next plan to conduct a systematic review and meta-analysis to assess trends in cardiovascular mortality among patients receiving different cancer therapies. Based on the disparities noted in the study, Ayaz said there is a need to further study the potential role of factors such as socioeconomic status, insurance status and health care access in clinical trials for colorectal cancer.

Reference:

Colorectal cancer linked with increased risk of cardiovascular mortality, American College of Cardiology, Meeting: American College of Cardiology’s Annual Scientific Session.

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Increased risk of COPD observed in individuals using e-cigarette: Study

A new study published in the journal of Respiratory Medicine showed a strong correlation between a higher risk of chronic obstructive pulmonary disease (COPD) and electronic nicotine delivery systems (ENDS).

In the early 2000s, electronic cigarettes, also known as e-cigarettes, were first released as vaping devices that produced vapor by heating an e-liquid. By simulating traditional cigarettes through simultaneous motor and sensory stimulation, e-cigarettes made it easier to limit or stop using traditional tobacco products.

In particular, e-cigarette users are more likely to acquire chronic respiratory conditions, including chronic obstructive pulmonary disease, and cardiovascular disorders like atherosclerosis, arrhythmia, myocardial infarction, hypertension, and heart failure. Furthermore, e-cigarette usage may worsen pre-existing respiratory issues, which might lessen the efficacy of Continuous Positive Airway Pressure (CPAP) in treating sleep apnea, a disorder that frequently co-occurs with COPD.

Pooled estimates of the effect of e-cigarette usage on COPD are currently scarce. The influence of e-cigarette usage on COPD is therefore assessed in the current meta-analysis of extensive population-based observational studies. In accordance with PRISMA Guidelines, a systematic search of observational studies published between January 2020 and January 2024 was carried out in MEDLINE and Scopus for this study.

A total of 7 observational studies (including 4 cross-sectional studies and 3 prospective cohort studies) out of the 3670 publications that were initially retrieved matched all search criteria and were incorporated in the current meta-analysis. These studies included 35,52,424 individuals in total, including 1,38,698 cases with COPD.

According to the results of the random-effects meta-analysis, e-cigarette usage among non-cigarette users was linked to a 1.50-fold increased risk of COPD (pooled Relative Risk, pRR). The results indicated above were validated by sensitivity analysis using leave-one-out analysis.

According to stratified pooled effect estimates from prospective cohort studies and cross-sectional studies alone, e-cigarette users had a considerably greater risk of COPD, ranging from 52% to 55%. Overall, e-cigarette users are more likely to acquire COPD, according to the present meta-analysis. 

Reference:

Song, C., Hao, X., Critselis, E., & Panagiotakos, D. (2025). The impact of electronic cigarette use on chronic obstructive pulmonary disease: A systematic review and meta-analysis. Respiratory Medicine, 239(107985), 107985. https://doi.org/10.1016/j.rmed.2025.107985

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Insulin Resistance frequent in Non-Diabetics with NAFLD, reports research

A new study published in the journal of BMC Gastroenterology showed that insulin resistance was quite common in non-diabetic individuals with non-alcoholic fatty liver disease (NAFLD), and most patients were obese.

About 25% of adults worldwide suffer from NAFLD, making it the most common liver condition in the world. This illness can range widely, from cirrhosis to hepatocellular carcinoma (HCC), or from basic fatty liver (NAFL) to steatohepatitis (NASH). Lifestyle therapy, such as dietary modifications and physical exercise, are now the first-line treatment for NAFLD.

One of the key underlying mechanisms of NAFLD, in which the body needs more insulin to maintain regular metabolic processes, is insulin resistance (IR). IR is significantly influenced by lipotoxicity and dysregulation of lipid metabolism, which is also a major risk factor for the onset of Type 2 Diabetes Mellitus (T2DM).

By offering localized data on the prevalence of IR in non-diabetic persons with NAFLD, this study seeks to close this knowledge gap and provide fresh data to our understanding of IR and NAFLD. Thus, to assist in creating and reforming healthcare plans and preventative measures in the region, this study will also investigate the relationship between HOMA-IR and liver enzymes (ALT, AST). 

At Karachi’s Liaquat National Hospital two groups of 362 non-diabetic individuals with NAFLD were created: one with IR and one without. In order to assess hepatic steatosis, a physical examination, a clinical history, laboratory tests (fasting lipid profile, insulin, fasting glucose, and liver function tests), and abdominal ultrasonography with fibroscan were conducted. Hepatic steatosis was defined as having a Controlled Attenuation Parameter (CAP) score of > 238 dB/m, and metabolic syndrome was identified using certain clinical and laboratory criteria. Data analysis was done with SPSS version 27.

Of the 362 patients that were enrolled, 51.7% were men. Of the individuals, 311 (84.9%) exhibited insulin resistance. For HDL, FPG, LDL, fasting plasma insulin, and GGT, there were notable differences in insulin resistance. Insulin resistance is less common in male patients than in female individuals. individuals with metabolic syndrome are more likely than non-metabolic individuals to have insulin resistance. Overall, this study found that IR is highly prevalent among non-diabetic individuals with NAFLD in Pakistan, and a significant percentage of these patients are also obese.

Reference:

Kamani, L., Siddiqui, M., & Rahat, A. (2025). Frequency of insulin resistance among non-diabetic patients with non-alcoholic fatty liver disease using HOMA-IR: an experience of a tertiary care hospital in Karachi, Pakistan. BMC Gastroenterology, 25(1), 259. https://doi.org/10.1186/s12876-025-03790-6

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FDA Approves Dupilumab as First New Targeted Therapy for Chronic Spontaneous Urticaria in Over a Decade

The US Food and Drug Administration (FDA) has approved dupilumab (Dupixent) for the treatment of chronic spontaneous urticaria (CSU) in patients aged 12 and older, marking the first new targeted therapy for the condition in more than ten years, according to Regeneron and Sanofi.

“People with chronic spontaneous urticaria experience sudden, unpredictable hives and severe itch that cause a significant, and often overwhelming, burden on their everyday lives,” said Kenneth Mendez, President and Chief Executive Officer at the Asthma and Allergy Foundation of America. “The approval of this treatment offers patients more options and the chance to control their disease.”

“Dupixent is the first new targeted treatment for chronic spontaneous urticaria, or CSU, in over ten years, with pivotal trials demonstrating its ability to help patients significantly reduce the hallmark symptoms of intense itch and unpredictable hives associated with this disease,” said George D. Yancopoulos, M.D., Ph.D., Board co-Chair, President and Chief Scientific Officer at Regeneron, and a principal inventor of Dupixent. “With this FDA decision, Dupixent is now approved for seven chronic, debilitating atopic conditions driven in part by underlying type 2 inflammation, several of which have been shown to co-morbidly occur with CSU, such as atopic dermatitis and asthma – providing patients with one treatment that might help multiple atopy conditions. We look forward to bringing Dupixent to the more than 300,000 CSU patients in the U.S. with inadequately controlled disease on standard-of-care treatment who, until now, had limited treatment options.”

The U.S. approval is based on data from two Phase 3 clinical trials, Study A (n=136) and Study C (n=148), which included biologic-naïve patients aged 12 years and older who were symptomatic despite the use of antihistamines and assessed Dupixent as an add-on therapy to standard-of-care antihistamines, compared to antihistamines alone. Both trials met their primary and key secondary endpoints with Dupixent demonstrating reductions in itch severity and urticaria activity (a composite of itch and hives) compared to placebo at 24 weeks. Dupixent also increased the likelihood of well-controlled disease or complete response compared to placebo at 24 weeks. Study B (n=108) provided additional safety data and evaluated Dupixent in patients aged 12 years and older who were inadequate responders or intolerant to anti-IgE therapy and symptomatic despite antihistamine use.

Safety results from Study A, Study B and Study C were generally consistent with the known safety profile of Dupixent in its approved indications. In pooled data from all three trials, the most common adverse event (≥2%) more frequently observed in patients on Dupixent compared to placebo was injection site reactions.

“CSU patients with uncontrolled disease experience highly burdensome itch and hives that can significantly disrupt daily living,” said Alyssa Johnsen, M.D., Ph.D., Global Therapeutic Area Head, Immunology and Oncology Development at Sanofi. “This FDA approval provides a new treatment option to help address the underlying drivers of these severe and recurring signs and symptoms. Dupixent has the potential to improve outcomes for CSU patients who previously had limited treatment options.”

Dupixent is already approved for CSU in Japan, the United Arab Emirates (UAE) and Brazil. Submissions are currently under review with other regulatory authorities around the world including in the European Union.

About Chronic Spontaneous Urticaria

CSU is a chronic inflammatory skin disease driven in part by type 2 inflammation, which causes sudden and debilitating hives and recurring itch. CSU is typically treated with H1 antihistamines, medicines that target H1 receptors on cells to control symptoms of itch and urticaria. However, the disease remains uncontrolled despite antihistamine treatment in many patients, some of whom are left with limited alternative treatment options. These individuals continue to experience symptoms that can be debilitating and significantly impact their quality of life. More than 300,000 people in the U.S. suffer from CSU that is inadequately controlled by antihistamines.

About the Dupixent CSU Phase 3 Trial Program

The LIBERTY-CUPID Phase 3 program evaluating Dupixent for CSU consists of Study A, Study B and Study C. These trials were randomized, double-blind, placebo-controlled clinical trials that evaluated the efficacy and safety of Dupixent as an add-on therapy to standard-of-care antihistamines compared to antihistamines alone. Studies A and C were replicate trials that assessed patients aged 6 years and older who remained symptomatic despite the use of antihistamines. Study B was conducted in patients aged 12 years and older who were symptomatic despite use of antihistamines and were inadequate responders or intolerant to anti-IgE therapy. During the 24-week treatment period in all three trials, patients received an initial loading dose followed by 300 mg Dupixent every two weeks, except for pediatric patients weighing <60 kg who received 200 mg every two weeks.

In all three studies, the primary endpoint assessed the change from baseline in itch at 24 weeks (measured by the weekly itch severity score [ISS7], 0-21 scale). The key secondary endpoints (also assessed at 24 weeks) included change from baseline in itch and hives (weekly urticaria activity score [UAS7], 0-42 scale). Additional secondary endpoints assessed at 24 weeks evaluated the proportion of patients achieving well-controlled disease status (UAS7 ≤6) and the proportion of patients with complete response (UAS7=0).

The results from Studies A and B were published in The Journal of Allergy and Clinical Immunology. Study B did not meet the primary endpoint in the U.S. of reduction in ISS7 compared to placebo at 24 weeks.

About Dupixent

Dupixent is an injection administered under the skin (subcutaneous injection) at different injection sites. In adults with CSU who remain symptomatic despite H1 antihistamine treatment, Dupixent 300 mg is administered every two weeks after an initial loading dose. In patients aged 12 to 17 years with CSU who remain symptomatic despite H1 antihistamine treatment, Dupixent is administered every two weeks based on weight (200 mg for adolescents ≥30 to <60 kg, 300 mg for adolescents ≥60 kg) after an initial loading dose. Dupixent is intended for use under the guidance of a healthcare professional and can be given in a clinic or at home after training by a healthcare professional. In adolescents aged 12 to 17 years, Dupixent should be administered under the supervision of an adult.

Dupixent, which was invented using Regeneron’s proprietary VelocImmune® technology, is a fully human monoclonal antibody that inhibits the signaling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways and is not an immunosuppressant. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are two of the key and central drivers of the type 2 inflammation that plays a major role in multiple related and often co-morbid diseases.

Regeneron and Sanofi are committed to helping patients in the U.S. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay® program. 

Dupixent has received regulatory approvals in more than 60 countries in one or more indications including certain patients with atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), eosinophilic esophagitis (EoE), prurigo nodularis, CSU and chronic obstructive pulmonary disease (COPD) in different age populations. More than 1,000,000 patients are being treated with Dupixent globally.

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Monocyte-to-HDL-C Ratio Linked to Gout and Kidney Dysfunction Risk: Study

China: A new cross-sectional study published in Scientific Reports has found that the monocyte-to-HDL-C ratio (MHR) is significantly associated with an increased risk of gout and the severity of renal dysfunction. These associations were particularly notable in specific subgroups, including males, Mexican Americans, married individuals, those with insufficient physical activity, and people with diabetes. The findings highlight MHR as a potential marker for identifying at-risk individuals.

Gout, a prevalent form of inflammatory arthritis, is often linked to increased monocyte levels and decreased high-density lipoprotein cholesterol (HDL-C). Despite these known associations, the potential of the monocyte-to-HDL-C ratio (MHR) as a marker for gout risk has not been thoroughly examined.

To address this gap, Ke Xu, Tongji Shanxi Hospital, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Taiyuan, China, and colleagues explore the relationship between MHR and the risk of developing gout, with a particular focus on cases complicated by renal dysfunction. The findings aim to offer a theoretical foundation that could support improved strategies for managing and preventing gout.

For this purpose, the researchers conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES, 2005–2016) to examine the association between monocyte-to-HDL-C ratio (MHR) levels and gout. They employed multiple logistic regression models, performed subgroup analyses, and explored potential nonlinear relationships to better understand the correlation and its implications.

The study revealed the following findings:

  • Among 7,247 participants, gout patients had significantly higher MHR levels (0.54 ± 0.31) than those without gout (0.47 ± 0.24).
  • After adjusting for confounding factors, a significant association was observed between elevated MHR and increased gout risk (OR = 1.6).
  • Subgroup analysis showed a positive correlation between higher MHR and gout risk in males, Mexican Americans, married individuals, people with insufficient physical activity, and those with diabetes.
  • In gout patients with renal dysfunction, MHR levels were even higher (0.6 ± 0.5), with a stronger association with gout risk (OR = 7.4).
  • The prevalence of gout with renal dysfunction was 1.7 times higher in participants in the highest MHR quartile compared to those in the lowest quartile (OR = 2.7).

“These findings indicate a strong positive correlation between the monocyte-to-HDL-C ratio (MHR) and gout risk in U.S. adults, along with a clear association between MHR levels and the severity of renal dysfunction in individuals with gout,” the authors wrote. They added that the results underscore the potential of MHR as a valuable biomarker for assessing both the risk and complications of gout, including renal involvement.

They concluded that incorporating MHR into clinical evaluations could improve the management of gout. However, they emphasized the need for large-scale prospective studies to validate these findings and further explore their clinical applicability.

Reference:

Mi, L., He, X., Gao, J. et al. Monocyte-to-HDL cholesterol ratio (MHR) as a novel Indicator of gout risk. Sci Rep 15, 12188 (2025). https://doi.org/10.1038/s41598-025-97373-w

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Popular diabetes medications, including GLP-1 drugs, may protect against Alzheimer’s disease, finds study

A study led by researchers in the University of Florida College of Pharmacy has found that a pair of popular glucose-lowering medications may have protective effects against the development of Alzheimer’s disease and related dementias in patients with Type 2 diabetes.

In research published in JAMA Neurology on April 7, UF researchers studied Medicare claims data of older adults with Type 2 diabetes to assess the association among glucagon-like peptide-1 receptor agonists, or GLP-1RAs, sodium-glucose cotransporter-2 inhibitors, or SGLT2is, and the risk of Alzheimer’s disease and related dementias.

The research is supported by funding from the National Institute on Aging and the National Institute of Diabetes and Digestive and Kidney Diseases, both part of the National Institutes of Health.

The data showed a statistically significant association between a lower risk of Alzheimer’s and the use of GLP-1RAs and SGLT2is compared with other glucose-lowering medications. According to the researchers, the findings indicated that the two drugs may have neuroprotective effects for people without diabetes and may help slow the rate of cognitive decline in Alzheimer’s patients.

Serena Jingchuan Guo, M.D., Ph.D., an assistant professor of pharmaceutical outcomes and policy and the study’s senior author, said these findings may point to new therapeutic uses for drugs commonly used to treat Type 2 diabetes and obesity.

“It’s exciting that these diabetes medications may offer additional benefits, such as protecting brain health,” Guo said. “Based on our research, there is promising potential for GLP-1RAs and SGLT2is to be considered for Alzheimer’s disease prevention in the future. As use of these drugs continues to expand, it becomes increasingly important to understand their real-world benefits and risks across populations.”

Guo conducted this research in collaboration with William Donahoo, M.D., clinical professor and chief of the UF Health Division of Endocrinology, Diabetes and Metabolism, and Steven T DeKosky, M.D., deputy director of the McKnight Brain Institute and professor of Alzheimer’s research, neurology and neuroscience in the UF Department of Neurology. As the study only included patients with Type 2 diabetes, Guo said next steps include evaluating the effects of the two drugs in broader populations by using recent, real-world data that captures their growing use in clinical settings.

“Future research should focus on identifying heterogeneous treatment effects-specifically, determining which patients are most likely to benefit and who may be at greater risk for safety concerns,” Guo said.

Reference:

Tang H, Donahoo WT, DeKosky ST, et al. GLP-1RA and SGLT2i Medications for Type 2 Diabetes and Alzheimer Disease and Related Dementias. JAMA Neurol. Published online April 07, 2025. doi:10.1001/jamaneurol.2025.0353.

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Uninterrupted DOAC Use During Tooth Extraction Deemed Safe in new study

According to a recent study published in BMC Oral Health, patients taking direct oral anticoagulants (DOACs) can safely undergo tooth extractions without stopping their medications. Only 3% of DOAC users experienced clinically significant bleeding, compared to 11% of patients on warfarin. The bleeding associated with DOACs was generally mild and self-managed, with no major bleeding events or transfusions required. These findings support the continued, uninterrupted use of DOACs during dental procedures.

No consistent approach to the management of direct oral anticoagulants (DOACs) during and after oral surgery has been established. Thus, DOACs may be unnecessarily discontinued, raising the potential risk of life-threatening thromboembolism. To address the inconsistency in this approach, our study assessed the risk of bleeding and other complications in patients who continue to use DOACs during and after simple and surgical tooth extractions. Between May 2016 and December 2023, this prospective study recruited patients aged 18 years or older who were receiving a DOAC or warfarin and were in need of simple or surgical extractions of one or more teeth. Local haemostatic agents were being used to control bleeding. Patients were instructed to manage minor postoperative bleeding at home by biting down on gauze soaked in tranexamic acid for at least 30 min. After surgery, all patients were followed for 7 days. The chi-squared test compared dichotomous variables; the two-sample t-test, continuous variables; logistic regressions, dichotomous outcomes; and linear regressions, continuous outcomes. Results: In all, 354 teeth were extracted from 160 patients receiving DOACs and 56 patients receiving warfarin. The incidence of any type of postoperative bleeding was 27% in patients receiving DOACs and 37% in those receiving warfarin (OR 0.66, 95% CI: 0.28–1.57; p = 0.35). Most patients were able to manage any bleeding at home themselves. Clinically relevant bleeding necessitating prompt evaluation or a secondary surgical intervention by a dentist or healthcare professional occurred in 3% of patients receiving DOACs and 11% of patients receiving warfarin (OR 0.30, 95% CI: 0.08–1.06; p = 0.06). No reports of major bleeding requiring hospitalization or blood transfusion were found. Perioperative bleeding volume was comparable between the two groups. Patients receiving DOACs without interruption during surgery may have a lower risk of bleeding than those on warfarin. Patients may safely continue to use DOACs during and after simple and surgical extractions. This eliminates the potentially higher risk of serious thromboembolic events that are associated with a pause in anticoagulant therapy.

Reference:

Johansson, K., Becktor, J.P., Naimi-Akbar, A. et al. Continuous use of direct oral anticoagulants during and after simple and surgical tooth extractions: a prospective clinical cohort study. BMC Oral Health 25, 554 (2025). https://doi.org/10.1186/s12903-025-05949-9

Keywords:

Johansson, K., Becktor, J.P., Naimi-Akbar, A, Anticoagulants, Factor Xa inhibitors, Direct oral anticoagulants, Warfarin, Oral haemorrhage, Oral surgical procedures

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Low-Dose Naltrexone Shows No Significant Pain Relief in Fibromyalgia Trial

A new study published in the journal of CNS Drugs showed that low-dose naltrexone (LDN) did not outperform placebo in reducing pain intensity or altering pressure pain thresholds in fibromyalgia patients. The FINAL trial’s primary and exploratory analyses revealed no significant benefits of LDN in managing fibromyalgia-related pain.

Fibromyalgia has a complicated and multidimensional neurobiology, with theories of central sensitization. An opioid receptor antagonist called low-dose naltrexone (LDN) has become a novel treatment option for fibromyalgia patients, with the potential to lessen pain and enhance quality of life. Modification of central sensitization and improvement of pain inhibition are among the hypothesized mechanisms of LDN, which may be mediated via its anti-inflammatory qualities and effects on glial cell activity.

The aim of the secondary analyses was to investigate the possible effects of LDN in comparison to a placebo on 5 exploratory secondary outcomes in women with fibromyalgia following 12 weeks of treatment in the entire case population: pain tolerance, TSP, CPM, and upper and lower limb muscular endurance.

For 12 weeks, 99 fibromyalgia patients received either LDN or a placebo in the FINAL study, which was randomized and placebo-controlled. In the full case population (45 versus 47 individuals), we investigated the possible effects of LDN versus placebo on baseline changes in pain tolerance, temporal summation of pain, and conditioned pain modulation (CPM). A shoulder abduction test and the 30-second chair stand test were used to assess measures of muscle exhaustion.

With a larger enhancement after LDN therapy compared with placebo, the change in CPM was the only one of the five outcomes that demonstrated a meaningful between-group difference. According to within-group changes in CPM, the LDN group had a rise of 1.2 kPa, whereas the placebo group may have seen a drop of 0.8 kPa.

Overall, change in CPM was one of the five exploratory outcome measures that showed a significant difference between groups. A decline in CPM in the placebo group contributed to the between-group difference, and there was no correlation between the change in CPM and pain response, indicating that this finding is most likely erroneous.

Source:

Bruun, K. D., Christensen, R., Amris, K., Blichfeldt-Eckhardt, M. R., Bye-Møller, L., Henriksen, M., Alkjaer, T., Toft, P., Holsgaard-Larsen, A., & Vaegter, H. B. (2025). Effect of naltrexone on spinal and supraspinal pain mechanisms and functional capacity in women with fibromyalgia: Exploratory outcomes from the randomized placebo-controlled FINAL trial. CNS Drugs. https://doi.org/10.1007/s40263-025-01183-7

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Ketorolac Reduces ICU Stay and Bleeding in Aortic Dissection Patients, confirms study

Researchers have reported in a new study published in BMC Medicine that ketorolac, administered perioperatively, is associated with a decrease in intraoperative bleeding, decreased ICU lengths of stay, and reduced overall hospital costs for patients undergoing operation for acute Type A aortic dissection (aTAAD). The study was conducted by Zhi-Kang and fellow researchers.

Acute Type A aortic dissection (aTAAD) is a severe cardiovascular emergency involving disruption of the intimal layer of the aorta, with rapid hemodynamic decline and high mortality unless surgically treated. Laboratory studies have implied that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac may retard the progression of aortic dissection, but such evidence in human beings has not been available. This randomized controlled trial sought to assess whether perioperative ketorolac administration would safely and effectively enhance outcomes in aTAAD patients, with particular emphasis on mortality, organ malperfusion, and other postoperative parameters.

The trial included 110 patients who were eligible out of a total of 179 patients undergoing aTAAD surgery. Patients were randomly assigned to receive ketorolac or a placebo (0.9% saline solution).

  • Preoperative Dose: Given at least 2 hours prior to surgery — either 60 mg ketorolac intramuscularly or 2 ml saline.

  • Postoperative Dose: Extended for 48 hours — 30 mg ketorolac intramuscularly or 1 ml saline, twice a day.

Patients were monitored closely, with the main endpoints being safety and efficacy, with an emphasis on mortality and organ malperfusion incidence. Secondary endpoints were drug-related adverse events, intraoperative bleeding, duration of ICU stay, and hospital cost. Of 110 randomly assigned patients, one from the ketorolac group withdrew due to erythroderma, resulting in 54 patients in the ketorolac group and 55 in the placebo group being available for final analysis.

Key Findings

Although the two groups were similar in terms of the main outcomes of mortality and organ malperfusion, several secondary benefits occurred in the ketorolac group:

Intraoperative bleeding:

  • Ketorolac group: Median of 1.8 liters

  • Placebo group: Median of 2.0 liters

  • Statistical significance: P = 0.03

Duration of stay in the ICU:

  • Ketorolac group: Median of 6.5 days

  • Placebo group: Median of 8 days

  • Statistical significance: P = 0.04

Hospital costs:

Total hospital costs:

  • Ketorolac group: Median of ¥170,430

  • Placebo group: Median of ¥187,730

  • Statistical significance: P = 0.03

  • No increase in drug-related adverse effects was significant, and the overall safety profile of ketorolac was acceptable throughout the perioperative period.

Short-term administration of ketorolac in acute Type A aortic dissection patients did not affect primary outcomes such as mortality and organ malperfusion, but it resulted in substantial decreases in intraoperative bleeding, ICU stay time, and hospitalization expense. These findings affirm the safety and peroperative potential of ketorolac in aTAAD treatment.

Reference:

Lv, ZK., Zhang, HT., Cai, XJ. et al. Ketorolac in the perioperative management of acute type A aortic dissection: a randomized double-blind placebo-controlled trial. BMC Med 23, 188 (2025). https://doi.org/10.1186/s12916-025-04021-1

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