The American College of Chest Physicians (ACCP) recently published updated guidelines for managing antiplatelet agents and anticoagulants in patients undergoing surgery or procedures that may involve bleeding; the previous guidance was from 2012 and did not include direct oral anticoagulants (DOACs). We added the new guidelines to our Periprocedural antithrombotic recommendations page, which also includes guidance from the AHA, ASGE, and SEC. Recommendations are grouped by indication and available at the links below.

• Antiplatelet drugs
• Atrial fibrillation (DOACs)
• Mechanical heart valves
• Venous thromboembolism (DOACs)
• Bridging therapy

For the first time, the American Academy of Pediatrics is recommending that providers offer obese children 12 years and older weight loss drugs as part of their initial treatment, as opposed to considering them only after other interventions fail (AAP obesity guidelines). With the recent approval of Wegovy in adolescents, there are now four FDA-approved drugs available to treat childhood obesity - Wegovy, Saxenda, Qsymia, and Orlistat. The guidelines also mention metformin as an option, which seems odd since studies have never found it to have a meaningful weight-loss effect.

Adolescent weight loss trials:

• Wegovy
• Saxenda
• Qsymia
• Orlistat

Leqembi® (lecanemab-irmb), a monoclonal antibody that binds with high affinity to amyloid-beta soluble protofibrils, was approved to treat Alzheimer's disease in patients with mild dementia; beta-amyloid pathology should be confirmed by PET or CSF measurements before therapy. It is given as an IV infusion once every 2 weeks, and periodic MRIs are required to monitor for amyloid-related imaging abnormalities (e.g. brain edema, microhemorrhages, superficial siderosis). In its pivotal trial (N=1795), average change from baseline in the CDR-SB score (scale 0 - 18, with higher being worse | average baseline score 3.2) was +1.21 in Leqembi-treated patients and +1.66 in placebo-treated patients after 18 months (p<0.001) [PubMed abstract].

The effects of Leqembi were very modest, with a difference compared to placebo of 0.44 on an 18-point dementia scale, which equates to a 2.5% improvement. Alzheimer's is an dreadful disease with few options. Hopefully, longer-term use of Leqembi will show a greater benefit.

• Leqembi prescribing information
• New Alzheimer’s Drug Leqembi Will Be Out of Reach for Most Patients, WSJ Jan 7, 2023

Are Noncompete Clauses Going Away?

Noncompete clauses are common in physician contracts, although people have different opinions on their legality. Multiple news outlets are reporting that the Federal Trade Commission is considering banning them.

• FTC Proposes Banning Noncompete Clauses for Workers, WSJ Jan 5th, 2023

Cologuard commercials run nonstop, and it's not hard to talk people out of a colonoscopy. So what should patients know before they skip the gastroenterologist and take advice from a talking box with arms and legs?

• Cologuard pros and cons