Full four-pillar guideline-directed medical therapy remains the foundation for heart failure with reduced ejection fraction, and finerenone now extends disease-modifying options into the mildly reduced and preserved ejection fraction range, but the persistent gap is implementation in the highest-risk patients rather than a lack of proven therapies.
All three FDA-approved medications for opioid use disorder are effective, but buprenorphine-naloxone offers a modest edge in overdose prevention, and treatment continuity plus harm reduction matter more than agent choice alone.
Imaging-based selection now extends intravenous thrombolysis to 9 hours and wake-up stroke, and tenecteplase has become an equal first-line agent to alteplase within 4.5 hours, but adding a late-window lytic on top of thrombectomy in perfusion-selected large-vessel occlusion has not improved functional outcomes.
Across obesity, cardiovascular disease, heart failure with preserved ejection fraction, chronic kidney disease, metabolic dysfunction-associated steatohepatitis, and even alcohol use disorder, GLP-1 receptor agonist (GLP-1RA) benefit tracks the patient's comorbid disease profile more than any BMI threshold, and pharmacists should frame these agents as indefinite, disease-targeted chronic therapy.
In atrial fibrillation, the anticoagulation risk-benefit calculus now hinges on drug-specific reversal (idarucizumab for dabigatran, off-label four-factor prothrombin complex concentrate as the pragmatic default for factor Xa inhibitors after andexanet's withdrawal) and on left atrial appendage closure as a bleeding-sparing but not stroke-superior alternative in selected patients.
Finerenone now has randomized evidence for cardiorenal protection across type 2 diabetic and non-diabetic albuminuric chronic kidney disease (CKD), and should be considered as an add-on to maximally tolerated renin-angiotensin system (RAS) blockade with a structured potassium monitoring plan rather than reserved for advanced disease.
For extracranial warfarin and factor Xa inhibitor major bleeding, fixed-dose four-factor prothrombin complex concentrate (4F-PCC) is a reasonable, faster, and more resource-sparing default when paired with a repeat-dose pathway, while weight and international normalized ratio (INR) based dosing remains preferred for vitamin K antagonist associated intracranial hemorrhage.
Subscribe for full access to every practice review, plus every deep analysis we publish.
Subscribe →