Internal Medicine Alert – May 30, 2025

Stroke Risk in Patients with New AFib During Unrelated Hospitalization

In a Canadian administrative database study of patients who developed atrial fibrillation during a hospitalization for other reasons, researchers followed the patients for one year to ascertain the risk of subsequent stroke. The incidence of stroke in those not anticoagulated generally was below the 2% per year threshold recommended for treatment with anticoagulants. However, in those with a CHA₂DS₂-VA score ≥ 5 (sex not included based on new data) and in those admitted for cardiac medical problems, the 95% confidence intervals of stroke risk did cross 2%. Thus, selected patients may be candidates for anticoagulation.

Does Thoracentesis Speed Recovery from Heart Failure?

An unblinded, multicentered, randomized trial of patients with acute heart failure hospital admissions and significant pleural effusions showed that early thoracentesis, in addition to recommended medical therapy, did not reduce mortality or length of stay, or increase days alive out of the hospital for 90 days. However, it was relatively safe and could be employed in selected persistently symptomatic patients with very large effusions.

Best Long-Term Antiplatelet Monotherapy Post-PCI

In a multicenter, randomized, open-label trial of clopidogrel vs. aspirin monotherapy in patients post-percutaneous coronary intervention (PCI) who had been on dual antiplatelet therapy for the recommended period, those randomized to clopidogrel showed fewer major cardiovascular or cerebral events over a two-year follow-up period than those on aspirin without an increase in bleeding events.

Vasectomy Follow-Up Rates: How Good Are They?

In this retrospective cohort study of 2,567 patients at a single institution, 42.1% of men did not follow up at all after vasectomy for semen analysis. Of those with spermatozoa on the initial testing post-vasectomy, 43.3% of men failed to return for repeat testing.

Atrasentan Tablets (Vanrafia)

The U.S. Food and Drug Administration has approved atrasentan, the first selective endothelin A receptor (ET_AR) antagonist to reduce proteinuria in adults with immunoglobulin A nephropathy. It was approved under accelerated approval based on surrogate outcome. Continued approval may be contingent on verification of clinical benefit in a confirmatory clinical trial. Atrasentan is distributed by Novartis Pharmaceuticals Corporation as Vanrafia.