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Hi, everyone.

This is John Mandrola from the heart.org medscape cardiology, and this is this week in

cardiology for October 17th, 2025. This week, some listener feedback, another knock against

the anti-platelet, anti-coagulation combination, polypills in heart failure, the physical exam of the future,

and the problem of underpowered trials and even a Bayesian analysis

cannot rescue. First listener feedback is I received an email from a young colleague in Italy

who wondered about my comments last week on low molecular weight heparin for patients with a fib.

I remarked about how aggravating it is that hospital doctors give heparin or low molecular

weight heparin acutely for AFIB.

It's aggravating because it's utterly non-evidence-based.

Not a single trial has ever studied the acute administration of sub-Q or IV anticoagulation

for atrial fibrillation.

My colleague wrote, quote, I've seen many expert colleagues giving it temporarily for one day or two

to patients coming to the ED with the new diagnosis of AFIB before switching to a DOAC.

I don't really understand the reason why they don't just give the DOAC since day one, which of course is exactly correct.

I mean, enoxyparin is dose every 12 hours and so is a pixaband.

If you want to anticoagulate the patient with AF, why not just start them on the pill, which will be used long term.

To me, the use of haparin or enoxaparin, the habit of doing these

things is kind of a marker for slow thinking. Furthermore, the notion that people with AFIB

...