Research ArticleResearchMedication SafetyPatient Education

Extended dual antiplatelet therapy lowered composite ischemic events after multivessel PCI without a detected bleeding increase

The New England journal of medicine (PubMed)Jul 16, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In an open-label randomized trial of 8,250 event-free patients one year after multivessel drug-eluting stent PCI, another year of clopidogrel plus aspirin reduced cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus aspirin alone, without a significant increase in clinically relevant or major bleeding.

What NurseJet pulled from the source

This open-label trial randomized 8,250 adults at 97 centers in China after they completed 12 event-free months of dual antiplatelet therapy following drug-eluting stent implantation for multivessel coronary disease. Patients received another 12 months of clopidogrel plus aspirin or aspirin alone. At 36 months, the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke occurred in 5.8% versus 6.8% (hazard ratio 0.82, 95% CI 0.69 to 0.98). Clinically relevant or major bleeding occurred in 1.4% versus 1.5% and did not differ significantly. The result applies to the selected stable, event-free population studied and does not make extended therapy appropriate for every post-PCI patient.

Why this matters for nurses

Cardiology nurses reinforce antiplatelet adherence, reconcile medications, assess bleeding, and teach patients when to seek help after PCI. This trial adds evidence for a selected multivessel-disease population while preserving the need for individualized prescribing decisions.

Bedside takeaway

Extended DAPT reduced composite ischemic events in selected event-free multivessel-PCI patients, so verify the prescribed duration and keep bleeding surveillance active.

How This Applies in Practice

Use this when: Reconciling or teaching an antiplatelet plan for a stable patient after multivessel drug-eluting stent PCI.

On your shift

Confirm the prescribed agents and intended duration at admission, transfer, and discharge, and address discrepancies with the prescriber.
Assess adherence and bleeding symptoms and ask about interacting medicines or planned procedures that require care-team review.

Keep in mind: Do not stop, restart, or extend antiplatelet therapy from this trial alone. Follow facility policy and patient-specific cardiology and provider orders.

Explain this for my unit

Key takeaways

The trial randomized 8,250 patients at 97 centers after 12 event-free months following multivessel PCI.
The composite ischemic outcome occurred in 5.8% with extended DAPT and 6.8% with aspirin alone at 36 months.
Clinically relevant or major bleeding was 1.4% versus 1.5% and did not differ significantly.
The findings apply to selected stable patients who tolerated the first year of dual therapy without major ischemic or bleeding events.

Practice implications

Confirm the intended antiplatelet duration during transitions of care and assess adherence, bleeding symptoms, interacting medicines, and upcoming procedures. Do not stop or extend therapy based on the study alone; route concerns to the cardiology or prescribing team.

Limitations & cautions

The trial was open label, conducted at 97 centers in China, enrolled patients 18 to 75 years old, and selected only those without major ischemic or bleeding events during the first 12 months of DAPT. The findings may not generalize to higher-bleeding-risk patients, older adults, other regimens, or patients with an event during the first year.
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Citations

Exact source links

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The New England journal of medicine (PubMed)

The New England journal of medicine (PubMed). Extended Dual Antiplatelet Therapy for Multivessel Coronary Artery Disease.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42456136/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Journal of clinical nursing (PubMed)Jul 16, 2026Systematic ReviewPractice applicable

A mixed-methods systematic review of 18 studies found that continuous bedside pressure mapping supported timelier repositioning and staff and patient awareness, but randomized trials did not show a significant overall preventive effect on pressure injuries.

Med-SurgAI summaryReview source

Systematic ReviewResearchWorkflowQuality ImprovementPractice applicableAI summary · original source linked below

This prospectively registered mixed-methods systematic review searched eight databases and included 18 studies of continuous bedside pressure mapping in adult hospital and long-term care settings. Observational cohorts suggested lower pressure-injury incidence in selected high-risk settings, but randomized trials found no significant overall preventive effect. An exploratory meta-analysis of interface pressure showed a borderline reduction with substantial heterogeneity that was not robust in sensitivity analysis. Process findings were more encouraging: the technology was associated with timelier repositioning, greater staff knowledge, and patient awareness and acceptability. The authors position pressure mapping as decision support alongside established prevention protocols, not as a stand-alone intervention.

Key takeaways

The review included 18 studies across adult hospital and long-term care settings.
Randomized trials did not show a significant overall pressure-injury prevention effect.
The exploratory interface-pressure result was borderline, heterogeneous, and not robust to sensitivity analysis.
Pressure mapping was associated with timelier repositioning and greater staff and patient awareness.

Why this matters on shift

Wound-care nurses and bedside teams often lead repositioning, skin surveillance, and pressure-injury prevention workflows. This review matters because it separates useful workflow feedback from the still-uncertain evidence that the technology prevents injuries.

Bedside takeaway

Bedside pressure mapping may improve repositioning workflows, but current randomized evidence does not show clear pressure-injury prevention.

Nursing implications

Use continuous pressure mapping, where approved, to inform repositioning and patient education while continuing established risk assessment, skin inspection, support-surface, and repositioning protocols. Evaluate workload, alert thresholds, and local outcomes rather than assuming that better process measures guarantee fewer injuries.

Limitations & cautions

The 18 studies used varied designs, settings, protocols, and outcomes. Observational findings may be confounded, randomized trials did not show a significant overall preventive effect, and the exploratory pressure meta-analysis had substantial heterogeneity and was not robust to sensitivity analysis. Economic evidence was also limited.
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Citations · exact source links

Journal of clinical nursing (PubMed). The Effectiveness of Continuous Bedside Pressure Mapping for Pressure Injury Prevention: A Mixed-Methods Systematic Review.

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Support Care Cancer (PubMed)Jul 16, 2026Systematic ReviewPractice applicable

A network meta-analysis of 54 randomized trials involving 10,455 adults found that olanzapine-containing regimens improved chemotherapy-induced nausea and vomiting outcomes; 5 mg preserved substantial efficacy relative to 10 mg, but lower dosing did not clearly reduce sedation.

Oncology Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyPractice applicableAI summary · original source linked below

This systematic review and frequentist network meta-analysis searched PubMed, Embase, and CENTRAL through April 9, 2026 and included 54 randomized trials with 10,455 adults receiving chemotherapy. Olanzapine-containing regimens consistently improved complete response, complete control, no-nausea, and no-vomiting outcomes versus placebo-containing regimens across acute and delayed phases. Although 10 mg generally had the numerically largest efficacy estimates, direct comparisons between 10 mg and 5 mg did not show statistically significant efficacy differences, and 5 mg appeared comparable in highly emetogenic chemotherapy populations. Reducing the dose from 10 mg to 5 mg did not clearly lower sedation risk, and evidence for 2.5 mg remained very limited.

Key takeaways

The network meta-analysis included 54 randomized trials and 10,455 adults receiving chemotherapy.
Olanzapine-containing regimens improved multiple nausea and vomiting outcomes versus placebo-containing regimens.
Direct comparisons did not show significant efficacy differences between 10 mg and 5 mg.
Dose reduction to 5 mg did not clearly reduce sedation, and evidence for 2.5 mg was very limited.

Why this matters on shift

Oncology nurses assess nausea control, oral intake, function, and medication adverse effects across chemotherapy cycles. This review matters because it clarifies that a lower olanzapine dose may retain efficacy while not reliably eliminating the sedation concern.

Bedside takeaway

Olanzapine 5 mg retained substantial CINV-prevention efficacy versus 10 mg, but lower dosing did not clearly remove sedation risk.

Nursing implications

Assess both breakthrough nausea or vomiting and sedation when olanzapine is part of an ordered antiemetic regimen. Do not interpret a lower dose as sedation-free, and communicate symptom-control or tolerability concerns to the oncology team rather than changing prophylaxis independently.

Limitations & cautions

Network estimates combine direct and indirect comparisons across different chemotherapy regimens, emetogenic-risk groups, and antiemetic backbones. The abstract does not report certainty ratings for each comparison. Evidence for 2.5 mg was sparse, and dose reduction from 10 mg to 5 mg did not clearly reduce sedation.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Support Care Cancer (PubMed). Olanzapine (10 mg vs 5 mg vs 2.5 mg) for the prophylaxis of chemotherapy-induced nausea and vomiting (CINV) - a systematic review and network meta-analysis.

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European journal of pediatrics (PubMed)Jul 16, 2026Systematic ReviewPractice applicable

A meta-analysis of 10 randomized trials involving 690 neonates found that higher-dose IVIG combined with phototherapy was associated with fewer exchange transfusions, shorter phototherapy and hospitalization, and lower 24-hour bilirubin than lower-dose IVIG, without a detected difference in adverse reactions.

Peds Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyPractice applicableAI summary · original source linked below

This systematic review searched five international and four Chinese databases through February 2026 and included 10 randomized trials with 690 neonates who had hemolytic disease. Compared with lower-dose IVIG plus phototherapy, higher-dose IVIG was associated with lower odds of exchange transfusion (Peto OR 0.24, 95% CI 0.12 to 0.50), about 9 fewer hours of phototherapy, a hospital stay shorter by about 1.8 days, and lower bilirubin at 24 hours. Hemoglobin at 72 hours and reported adverse-reaction rates did not differ significantly. The authors call for larger, higher-quality trials and note that blood-group subtype may affect response.

Key takeaways

The meta-analysis included 10 randomized trials and 690 neonates with hemolytic disease.
Higher-dose IVIG was associated with lower odds of exchange transfusion than lower-dose IVIG.
Phototherapy duration, hospital stay, and 24-hour bilirubin also favored the higher-dose groups.
Adverse-reaction rates did not differ significantly, but larger high-quality trials are needed.

Why this matters on shift

Pediatric and neonatal nurses closely monitor bilirubin trends, phototherapy delivery, hydration, neurologic status, and infusion reactions. This review matters because it synthesizes dose-comparison evidence while leaving the clinical choice of IVIG and dose within the neonatal treatment protocol.

Bedside takeaway

Higher-dose IVIG plus phototherapy was associated with fewer exchange transfusions, but the dose decision still belongs to the neonatal protocol and care team.

Nursing implications

When IVIG is ordered for neonatal hemolytic disease, verify the weight-based dose and infusion plan, maintain prescribed phototherapy, and trend bilirubin and clinical status on schedule. Promptly escalate worsening jaundice, neurologic concerns, or an infusion reaction through the neonatal pathway.

Limitations & cautions

The analysis included 10 trials and 690 neonates, and the abstract does not provide study-level risk-of-bias or certainty ratings. Trials were drawn from international and Chinese databases, blood-group subtypes may modify response, and the absence of a statistically significant adverse-event difference does not establish equivalent safety.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European journal of pediatrics (PubMed). Efficacy and safety of different doses of intravenous immunoglobulin combined with phototherapy in neonatal hemolytic disease: a systematic review and meta-analysis.

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AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Bedside pressure mapping improved repositioning processes, but randomized trials did not show clear pressure-injury prevention

Olanzapine 5 mg preserved substantial antiemetic efficacy versus 10 mg, but dose reduction did not clearly lower sedation risk

Higher-dose IVIG with phototherapy was associated with fewer exchange transfusions in neonatal hemolytic disease