In this episode of Inpatient Update, Dr. Mason Turner is joined by Dr. Andres Ospina, fellow hospitalist, to discuss two recent trials with immediate impact on hospital practice:

• Aspirin plus anticoagulation in chronic coronary disease (AQUATIC Trial) — does keeping aspirin help or harm when long-term anticoagulation is started?
• Seven vs fourteen days of antibiotics for bloodstream infection (BALANCE Trial) — can we safely cut bacteremia treatment in half?

Practical take-homes, clear links to the evidence, and what to change on rounds tomorrow.

Articles & PubMed Links

Aspirin in Patients with Chronic Coronary Syndrome Receiving Oral Anticoagulation (AQUATIC Trial)

New England Journal of Medicine (October 2025)

Key Findings:

• Higher morbidity and mortality with dual therapy (HR 1.53)

Bottom Line:
In stable CAD >6 months from revascularization, if anticoagulation is started, stop the aspirin.

Pubmed: https://pubmed.ncbi.nlm.nih.gov/40888725/

Antibiotic Treatment for Bloodstream Infection (BALANCE Trial)

New England Journal of Medicine (November 2024)

Multicenter, randomized, non-inferiority trial (n≈3,600)

Bottom Line:
In uncomplicated bacteremia with source control and no severe immunocompromise, 7 days is non-inferior to 14.

Pubmed: https://pubmed.ncbi.nlm.nih.gov/39565030/

Practice-Changing Takeaways

• Stable CAD + new anticoagulation? Stop aspirin if >6 months from PCI/CABG.
• Uncomplicated bacteremia? Seven days of antibiotics is sufficient in most cases (excluding Staph aureus and deep-seated infection).

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