The shift in cardiovascular disease. From reduction of heart attacks, coronary artery disease, and strokes to more atrial fibrillation ("the most common cardiovascular problem") thelancet.com/journals/lance…

At #ESOC2025, Benjamin Maïer (Hôpital Fondation Adolphe de Rothschild) shared findings of the DETERMINE trial, which investigated individualized blood pressure management during mechanical thrombectomy for anterior acute ischemic #stroke. Watch here: 👉 ow.ly/1YH050W1svX European Stroke Org

Vitamin D supplementation may reduce respiratory infections in children, mortality in older adults, and diabetes progression in prediabetics, with inconclusive evidence for other benefits. ja.ma/4n0yEZh

A good diagnostic algorithm for headache!

Direct comparison of apixaban with rivaroxaban for treatment of VTE shows excess bleeding with rivaroxaban in the COBRA randomized trial.

It's official. For acute stroke treatment, Alteplase (tPA) is out, and Tenecteplase (TNK) is in. But why? And more importantly, why is it called TNK when there’s no “K” in Tenecteplase?? 🧵

Compared to tPA: 🧪 TNK has 5x longer half-life 🧪 More fibrin-specific (higher rates of recanalization?) 🧪 Less fibrinogen depletion (lower risk of bleeding?) The genetic tweaks made it more targeted, potentially making it it safer & more effective.

In fibrinolysis, tPA and TNK both convert plasminogen to plasmin, which breaks down fibrin clots. But TNK, with greater fibrin specificity, focuses action at the clot site, minimizing systemic effects.

But most importantly, the dosing is different, with very practical implications: - - tPA: 0.9 mg/kg (60-min infusion) - - TNK: 0.25 mg/kg (single bolus) TNK is easier, faster, and less error-prone. This is especially helpful in busy EDs or transfer scenarios.

The AcT trial (Canada, n=1600) showed TNK was non-inferior tPA for functional outcomes. That data was enough for FDA approval, despite being outside the U.S. After nearly 30 years, we finally have a new stroke thrombolytic! TNK is here to stay...

Sources: 1) rpthjournal.org/article/S2475-… 2) ahajournals.org/doi/full/10.11… 3) neurology.org/doi/abs/10.121…

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This is the Atlas of Cognitive Disorders

The mechanisms by which ultra-processed foods (UPF) drive obesity, an outstanding review article "the evidence is sufficiently strong to justify immediate public health efforts to reduce UPF consumption." nature.com/articles/s4157…

This is fabulous. It takes over 1800 overnight vital sign assessments among Neurology floor inpatients to generate one clinical actionable finding. Let your patients sleep! neurology.org/doi/10.1212/CP…

This is a fascinating new knowledge in Atherosclerotic Cardiovascular Disease!Revolution in medicine: A molecule produced by gut bacteria causes atherosclerosis, responsible for millions of deaths english.elpais.com/health/2025-07… via El País English Edition