THE ROUNDS REPORT
Skip the journal overwhelm. 50+ top medical journals distilled into a 3-minute read of the most compelling insights.
Between September and December, five major trials landed that force us to reconsider standard practice in post-MI management, stroke prevention, CLL treatment, PE intervention, and Long COVID therapy.
Here's what actually matters.
The Big Five Game-Changers
1. Beta-Blockers After MI: Not for Everyone Anymore
Post-MI beta-blockers have been automatic for decades. A new meta-analysis just shattered that reflex.
17,801 patients across five recent trials (NEJM, November 2025) showed beta-blockers provide no mortality benefit in patients with preserved left ventricular function (LVEF ≥50%) after MI. Risk ratio: 0.96, essentially nothing.
The benefit only appears in reduced LVEF patients: exactly the higher-risk subset we were already treating more aggressively anyway.
Practice implication: Your post-MI patient with normal EF on optimal medical therapy? Beta-blockers add pill burden without proven benefit.
2. Carotid Stenting Beats Medical Therapy; Surgery Doesn't
CREST-2 just rewrote the book on asymptomatic carotid stenosis.
The trial (NEJM, November 2025) tested both revascularization options against medical therapy in 2,485 patients. Stenting showed clear benefit: 2.8% stroke/death rate versus 6.0% with medical therapy alone (P=0.02). But endarterectomy? No significant benefit: 3.7% versus 5.3% (P=0.24).
This wasn't stenting versus surgery. Both were tested separately against medical therapy, and only stenting proved its worth.
Practice implication: For asymptomatic carotid stenosis requiring intervention, stenting demonstrated clear benefit while two decades of surgical preference didn't.
3. Fixed-Duration Therapy Matches Continuous Treatment in CLL
CLL patients can finally stop indefinite therapy.
CLL17 trial (NEJM, December 2025) showed fixed-duration venetoclax-obinutuzumab was noninferior to continuous ibrutinib in 909 patients: 3-year PFS of 81.1% versus 81.0%. Plus, 73.3% achieved undetectable MRD.
Practice implication: Offering a defined treatment endpoint (typically 12-15 months) versus indefinite daily therapy fundamentally changes the CLL treatment conversation.
4. Catheter-Assisted Thrombectomy Cuts RV Strain in Half
Intermediate-high risk PE patients have a new option beyond anticoagulation alone.
STORM-PE (Circulation, November 2025) randomized 100 patients to catheter-assisted vacuum thrombectomy plus anticoagulation versus anticoagulation alone. RV/LV ratio reduction: 0.52 versus 0.24 (P<0.001), essentially double the RV recovery.
Practice implication: For submassive PE with significant RV strain, mechanical thrombectomy offers faster hemodynamic recovery than anticoagulation alone.
5. Colchicine Fails for Long COVID
The Long COVID colchicine hypothesis just died.
HEAL-COVID (JAMA Internal Medicine, October 2025) tested colchicine in 346 patients with persistent Long COVID symptoms. Result: no improvement in 6-minute walk distance, respiratory function, or inflammatory markers compared to placebo.
Practice implication: The colchicine hypothesis for Long COVID just failed. The search for effective pharmacologic interventions continues.
Clinical Pearls That Matter
1. Provoked VTE with persistent risk factors: Extended apixaban (2.5 mg BID for 12 months) reduced recurrence by 87% in the HI-PRO trial: 1.3% versus 10.0% with placebo (NEJM, August 2025). Link
2. Coffee and atrial fibrillation: DECAF trial showed regular coffee consumption reduced AF recurrence by 39% versus abstinence: 47% versus 64% recurrence at 6 months (JAMA, November 2025). The evidence for coffee restriction in AF just evaporated. Link
Monday Morning Rounds: 5 Key Discussion Points
Beta-blockers showed no mortality benefit in preserved LVEF post-MI patients (RR 0.96) across 17,801 patients in five trials, questioning decades of automatic prescribing.
Carotid stenting reduced stroke risk versus medical therapy alone (2.8% vs 6.0%, P=0.02) while endarterectomy showed no significant benefit (3.7% vs 5.3%, P=0.24) in CREST-2's separate trial arms.
Fixed-duration venetoclax-obinutuzumab proved noninferior to continuous ibrutinib in CLL with 81% three-year PFS and 73% undetectable MRD rates.
Catheter-assisted thrombectomy doubled RV strain reduction versus anticoagulation alone in submassive PE (0.52 vs 0.24 RV/LV ratio reduction).
Colchicine showed no benefit for Long COVID symptoms across any measured outcome in 346 patients, eliminating a promising therapeutic hypothesis.
Essential Reading for Deep Dives
Cardiology & Stroke Prevention: • Beta-Blocker Meta-Analysis Post-MI • CREST-2 Carotid Stenting Trial • DECAF Coffee and Atrial Fibrillation Study
Hematology & Oncology: • CLL17 Venetoclax Fixed-Duration Trial • HI-PRO Extended VTE Prophylaxis
Pulmonary & Critical Care: • STORM-PE Mechanical Thrombectomy Trial
Infectious Disease & Post-Acute COVID: • HEAL-COVID Colchicine Trial
Before You Go
This quarter delivered paradigm shifts that challenge deeply ingrained practices. The beta-blocker meta-analysis exemplifies how medicine evolves: yesterday's standard becomes tomorrow's questioned dogma when the evidence actually gets examined at scale.
That's why this newsletter exists: to catch these inflection points when they happen, not years later when they're finally in guidelines.
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Disclaimer
The content provided in The Rounds Report is for educational and informational purposes only and does not constitute medical advice, diagnosis, treatment recommendations, or professional medical guidance. This newsletter presents summaries and analysis of published medical research and should not be used as a substitute for professional medical judgment, clinical decision-making, or consultation with qualified healthcare providers. Always consult with appropriate medical professionals and refer to original research sources before making any clinical decisions.
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