NEJM This Week NEJM This Week — September 25, 2025
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Sep 24, 2025 This week explores groundbreaking research on heart failure treatments and the implications of extended anticoagulation for venous thromboembolism. Delve into innovative therapies for chronic lymphocytic leukemia and the exciting outcomes of a trial on early treatment for ischemic stroke. The conversation also confronts structural racism in scientific funding, while celebrating significant advancements in cystic fibrosis research. Plus, a touching story about a compassionate doctor highlights the human side of medicine.
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Cardiac Glycoside Benefit With Caveats
- Digitoxin reduced death or hospitalization versus placebo in patients with HFrEF on guideline therapy in this trial.
- Trial size limits certainty but reminds clinicians of digoxin as a judicious option.
Individualize Anticoagulation After Provoked VTE
- Consider individualized discussions about extending anticoagulation after provoked VTE when persistent risks exist.
- Use risk factors, bleeding risk, and patient values rather than the binary provoked/unprovoked label.
MRD-Guided Deep Remissions In CLL
- Ibrutinib–venetoclax produced higher rates of undetectable MRD and longer progression-free survival than ibrutinib alone or FCR.
- The MRD-guided approach supports deeper remissions and consistent overall survival benefit.