Research ArticleResearchMedication SafetyPatient Education

Rivaroxaban produced more migraine responders than metoprolol in adults with PFO

BMJ (PubMed)Jul 29, 2026

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

Brief summary

A 39-center randomized trial of 984 analyzed adults with migraine and patent foramen ovale found aspirin, clopidogrel, and rivaroxaban non-inferior to metoprolol for the prespecified migraine response; rivaroxaban produced a higher responder rate than metoprolol.

What NurseJet pulled from the source

After a 12-week baseline period, participants received aspirin, clopidogrel, rivaroxaban, or metoprolol for 12 weeks. At least a 50% reduction in monthly migraine days or attacks occurred in 61.7%, 66.8%, 78.4%, and 61.8%, respectively. Rivaroxaban exceeded metoprolol by 16.2 percentage points, and no major bleeding events occurred during the trial.

Why this matters for nurses

Neurology and cardiac nurses may encounter patients whose migraine evaluation includes patent foramen ovale and an antithrombotic plan. The results inform medication education and surveillance, but they do not authorize nurses to initiate, substitute, or recommend an antithrombotic agent.

Bedside takeaway

Rivaroxaban produced more migraine responders than metoprolol over 12 weeks in adults with patent foramen ovale.

How This Applies in Practice

Use this when: Caring for an adult with migraine and patent foramen ovale who has a clinician-directed antithrombotic treatment plan.

On your shift

Reconcile the antithrombotic agent, dose, indication, allergies, interacting medications, and planned follow-up.
Complete ordered bleeding and neurologic assessments and document new symptoms or medication discrepancies.
Use teach-back for the prescribed regimen, missed-dose instructions, safety precautions, and when to seek urgent care.

Keep in mind: This trial does not support independent medication selection or substitution and provides only 12-week safety data. Follow medication-safety protocols, facility policy, and provider orders.

Key takeaways

The open-label trial randomized 1,000 adults with migraine and patent foramen ovale across 39 centers in China; 984 were included in the full analysis set.
Aspirin, clopidogrel, and rivaroxaban were each non-inferior to metoprolol for the prespecified migraine responder outcome.
Rivaroxaban produced a 78.4% responder rate versus 61.8% with metoprolol.
No major bleeding events occurred, but the 12-week trial does not establish longer-term comparative safety.

Practice implications

When caring for a patient enrolled in a clinician-directed antithrombotic plan, reconcile the exact agent and indication, complete ordered bleeding and medication-safety assessments, and reinforce prescribed follow-up. Escalate bleeding, new neurologic symptoms, pregnancy concerns, or medication discrepancies promptly.

Limitations & cautions

Treatment was open label, follow-up lasted 12 weeks, and participants with previous stroke, transient ischemic attack, intracranial hemorrhage, or medication contraindications were excluded. The trial was conducted in China and compared active treatments without a placebo group, limiting generalizability and long-term safety conclusions.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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BMJ (PubMed)

BMJ (PubMed). Antithrombotic treatment for migraine in patients with patent foramen ovale: multicentre, randomised, active controlled, open label trial.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42526943/

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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A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

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Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

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

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

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Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

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At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

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

One in four laboratory-defined AKI cases went undocumented on medicine wards

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