Teddy Padalack

Lactulose clinical pearls from 🆕 2026 #HepaticEncephalopathy guidelines @AmCollegeGastro Hospitalised with overt HE: 📌10-20g q2h till 2 soft BM, then down to 2-4/day for 2-3 soft BM/day 📌Enema 200g lactulose or 0.3L solution with 0.7L water/NS, retain for 30-60min, repeat q4-6h 📌High volume 4L PEG prep as alternative to lactulose 📌In intubated with FMS: hold lactulose if >300mL stool/day. Monitor for ⬆️ Na 👉 pubmed.ncbi.nlm.nih.gov/41773757/ @JasmohanBajaj @ebtapper @ArunJesudian @YucaSpice @umfoodoc @AmyOxentenkoMD @liverUSA @BavenoCoop @ISHENliver

Finally published: the COBRRA trial, the first randomized head-to-head comparison of major DOACs — something the companies would never have done themselves, as a direct confrontation goes beyond their commercial interests. This was driven by independent investigators. The results somewhat support the idea of apixaban being the “safer” DOAC. That said, the list of study limitations is long, and for me, labeling something as “safe” is not enough — after all, even placebo is “safe” when it comes to bleeding. nejm.org/doi/full/10.10…