🐍 COBRRA's, 🥵 Kawasaki and 🛜Wi-Fi Surgery?

Congratulations on surviving 50 hours this week.
You are now free to dissociate for two whole days 🥳 .

Unless you’re working the weekend. In which case, my condolences 💔
If nothing else, I hope this medical news can provide some respite 🤞

👋 Happy Friday. Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

🛎️ DING 🛎️ DING 🛎️ DING

Clinicians…

Are. 
You. 
Ready?

For a fight messier than ward politics…
For a battle bloodier than supratherapeutic INR…
For a tussle rougher than back-to-back night shifts…

For the very first time, two clot-stopping heavyweights step into the ring. 

In the blue corner…
It’s the darling of the DOAC era… 
Apixaban 

In the red corner… 
It’s the dark horse, yet ever effective… 
Riveroxaban 

Like all rivalries in the 2020’s, the beef was born on Twitter. ​​

You see, these two DOAC’s have had issues for years. Both are super effective against VTE and pulmonary embolisms. But there is one stat that always splits the two: Who bleeds less?

And the stage was set. The fight was announced for the biggest randomised control trial of 2026. Streaming exclusively on pay-per-view via the New England Journal of Medicine.

The COBRRA trial recruited 2760 adults with symptomatic acute proximal lower-limb DVT’s. Then randomised them 1:1 to receive either…

The primary aim being to determine if apixaban really is superior to rivaroxaban in reducing clinically relevant bleeding during the first 3 months of treatment for VTE. 

And after roughing it out for the full 12 rounds, the champion emerged.

And it was the golden boy… Apixaban.  

Apixaban caused about half as much clinically relevant bleeding as rivaroxaban over 3 months. Additionally:

Now, of course, no fight is ever that simple. This was an open-label trial(patients knew what they were getting); adherence differed slightly between groups, and patients with cancer or extreme body weight weren’t included.

But the conclusion is pretty darn clear. For patients in need of anticoagulation and who are at high bleeding risk, there is an obvious DOAC to go for.

Everyone always asks us.

“The Team of Handovia, where on earth do you acquire such quality medical news?” 

It’s a secret we’ve gatekept.
Kept sealed away.
Hidden as tightly as the Krabby Patty Secret Formula.

And as a result, rumours have started to spread.

“I heard they’ve bugged Wes Streeting’s iPhone…”
“I’ve heard they abducted a Lancet and Nature editor…”
“Reddit says they have an AI trained on ward gossip…”

Sorry to disappoint, the rumours are false. We’re just chronically online 💔
And one of our biggest sources of medical news is Doctors.net.uk

If The Handover is brainrot medicine.
Doctors.net.uk is the cure.

Their editorial team works around the clock, delivering the latest medical news to clinicians.
We just… dumb it down.

You see, Doctors.net.uk exists to do one thing: Make you tangibly better at your job.

They have:

Oh, and did I mention it's completely free? 

So if you want the news from the horse’s mouth, want to sharpen your clinical knowledge, and maybe make a little extra dosh…

Join over 270,000 clinicians using Doctors.net.uk and click below 👇

Let’s talk about everybody’s favourite childhood vasculitis.
That’s right. It’s Kawasaki time. 

You may know it for its high fevers of more than 5 days.
And it’s redness all over the shop: from tongue to toes, from lips to lymphs. 

While the symptoms can look pretty dramatic, the real problem is a little more insidious… Kawasaki is one of the leading causes of coronary artery aneurysms in children.

So naturally, doctors treat it aggressively.

IV immunoglobulins(IVIG) AND high-dose aspirin. STAT!

High-dose aspirin… in a kid? Yes! High-dose aspirin in a kid. 
Why high-dose aspirin, Doc? Umm, because the guidelines say so?

Yes, it does. But if you look at the timeline, this is where things get interesting…

You see, aspirin came first. 

In the 1970’s, there was no IVIG. As a result, clinicians threw everything they could to help calm the inflammatory storm. High-dose aspirin was the obvious choice…

In the mid 1980’s, IVIG burst on the scene. Immediately showing that it could dramatically reduce the risk of coronary artery aneurysms. Old habits die hard. High-dose aspirin wasn’t abandoned, just continued as the sidekick for the IVIG superhero. 

But does Batman really need Robin?
An increasing body of evidence suggests perhaps not as much…

High-dose aspirin does come with its risks, like GI bleeds and Reye's syndrome. So researchers decided to take a closer look.

This study, published in the Journal of the Paediatric Diseases Society, set out to investigate it.

This retrospective, single-centre cohort study aimed to compare coronary artery outcomes and the need for IVIG retreatment between children with Kawasaki disease treated either with:

The trial looked at 460 children (271 high-dose, 189 low-dose), all controlled for demographics, blood markers, use of corticosteroids, and timing of IVIG administration (median 7 days in both groups).

The researchers then tracked two main outcomes:

And here’s what they found:

Overall, IVIG retreatment occurred in:

Coronary artery outcomes told a similar story.
Changes in the right coronary artery (RCA) and left anterior descending artery (LAD) from baseline to their maximum recorded diameter were not significantly different between the two groups.

Bottom line: No need for the high-dose Aspirin.

However, with all studies, this had its limitations:

Whilst these limitations are significant, compounding this evidence with separate studies from Sanati et al. Dallaire et al. and the GOAT Zhang et al, a strong case can be made to rethink how we manage Kawasaki disease 🤔

Let’s just wait for NICE to catch up.

New Medication For The Menopause

One of the primary presenting complaints for women approaching the menopause is those damned hot flushes. Drenching through clothing, day and night. Not much fun at all.

Hormonal replacement therapy has done a world of good. But what about cases where it’s just not suitable? Like a history of breast cancers and DVTs?

Antidepressants used to be the go-to… But now a new non-hormonal treatment, called Fezolinetant(Pharma name, Veoza), has been approved by NICE.

It’s a selective neurokinin 3 receptor(NK3R) antagonist. AKA it blocks the nervous pathways that trigger hot flushes and night sweats. 

It’s a once-daily pill, and over 500,000 people are eligible for the treatment. 

If you’re in primary care, check out the draft guidance here

Gender Hormone Treatment for under-18’s Paused by the NHS

Not trying Nick Baumel’d here, so no jokes. 

The NHS has paused gender-affirming hormone treatment for under-18s with gender dysphoria.

Previously, adolescents aged 16 and 17 who met strict clinical criteria could be offered masculinising or feminising hormones to align their physical characteristics with their identified gender.

Following a review of the evidence (including recommendations from the Cass Review into children’s gender services), NHS England concluded that current evidence is insufficient to clearly demonstrate the benefits or risks of this treatment in young people.

So, new referrals have been paused while a 90-day consultation considers whether the therapy should remain available as a routine NHS service.

Young people already receiving treatment will continue, with their care reviewed individually by clinicians.

Magic Mushrooms for Smoking Cessation

When Varenicline, Bupropion, and NRT fail, who can come and save the day?

Sheer willpower? Never that. 

A new paper published in JAMA Open Network suggests psychedelics might hold the key. Who woulda thought.

This teeny weeny pilot RCT of 82 patients compared Psilocybin (the active ingredient in magic mushrooms) with therapy to the Nicotine patch with therapy. To see which group could abstain the longest. 

The findings were remarkable: 40.5% prolonged abstinence in the psilocybin group versus 10% with the nicotine patch.

Of course, it was just a small pilot trial, but bloody heck. This must be big news in the hippie community. 

Wireless Laparoscopic Surgery

And one last headline for my medtech fanatics. 

A London urologist has just performed the UK’s first remote robotic prostatectomy on a patient 1,500 miles away in Gibraltar.

Using the nifty Toumai robot, Professor Prokar Dasgupta sat at a console in London controlling four robotic arms and a 3D HD camera via fibre-optic cable with 5G backup. 

A local team stood ready in case the internet dropped out mid-prostate. Thankfully, it didn’t.

So, prostate out, patient happy, and surgeons now officially operating on Wi-Fi. Good stuff

And yes, I did just see this headline on Imjustbait’s meme account – med news can come from weird and wonderful places. 

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