Aspirin vs. Blood Thinners, a 9-Year Endo Wait Ends & Cyclospora Hits Taco Bell

Summary

---

Medlines Podcast Summary

Episode: Aspirin vs. Blood Thinners, a 9-Year Endo Wait Ends & Cyclospora Hits Taco Bell
Date: July 17, 2026
Hosts: Dr. Will Flanary (Dr. Glaucomflecken), Adam Rose

Episode Overview

This episode of Medlines delivers a whirlwind tour through key headlines in healthcare, focusing on a landmark NEJM trial on aspirin for blood clot prevention after joint replacement, new rapid testing for endometriosis, escalating cyclospora outbreaks linked to Taco Bell, an FDA recall of eye drops, and a medical drama dominating Emmy nominations. Designed for busy clinicians, the episode delivers front-line clinical insights, broader health policy moves, and a dose of peer-to-peer banter.

---

Key Discussion Points & Insights

1. Aspirin vs. Blood Thinners After Joint Replacement

[00:51 – 03:19]

• Main Story:
  The New England Journal of Medicine's EPCAT 3 trial evaluated whether aspirin alone is sufficient for blood clot prevention after elective hip or knee replacement in standard-risk patients.
• Trial Details:
  • 5,429 patients randomized after elective hip or knee replacement
  • Compared: Aspirin monotherapy vs. 5 days rivaroxaban (a DOAC or "direct oral anticoagulant") followed by aspirin
  • Prophylaxis duration: 14 days after knee, 35 after hip
  • Primary outcome: Proximal DVT or pulmonary embolism (PE)
• Findings:
  • Clot rates almost identical: 0.48% (aspirin) vs. 0.45% (rivaroxaban then aspirin)
  • Bleeding requiring reoperation: Only in 4 patients starting with rivaroxaban, none in aspirin-only group
  • Over 96% of participants were standard-risk; higher-risk patients still need individual assessment
• Implications:
  • "A familiar lower cost option without an initial course of a DOAC." (Adam, 02:18)
  • Trial supports that for standard risk joint replacements, low-dose aspirin may be enough
  • Non-inferiority: Aspirin is “just as good” as the current alternative in this specific group
• Memorable Moments:
  • Will: “I know orthopedic surgeons are all high-fiving somewhere about this, but that’s a pretty good week for one very old drug.” [03:05]

2. New Rapid Endometriosis Tests (NICE UK Recommendation)

[03:19 – 05:21]

• Background:
  Endometriosis diagnosis in the UK averages over 9 years; up to 11 years for ethnically diverse women
  • Symptoms: Pelvic pain, heavy bleeding, bowel/bladder issues, fertility concerns
  • Many endure years of symptoms, normal imaging, and misdiagnoses
• New Developments:
  • NICE (National Institute for Health and Care Excellence) draft guidance endorses two rapid tests:
    • Endosure: Sensor pads on abdomen, measures gut electrical signals after fasting; results in ~45 mins
    • Endotest: Saliva-based, detects microRNA biomarkers
  • A third test (dotendo) not yet approved; more research needed
• Goals & Cautions:
  • Intended for patients with suspected endometriosis after inconclusive imaging
  • Could avoid diagnostic laparoscopy, enable earlier treatment, free up OR time
  • “Endometriosis UK cautioned that faster testing only helps if patients are recognized early and referred appropriately.” (Will, 04:48)
• Quote:
  • Adam: “I think many of us have heard plenty about endometriosis over the years, but what had surprised me… it’s about 1 in 10 reproductive age women who suffer from endometriosis. So this really means a lot for a lot of people.” [05:06]

3. Quick Hits — "Off the Clock" Segment

[05:22 – 07:59]

- FDA Recall of Prednisolone Eye Drops

[05:30 – 06:06]

• 2.5 million bottles recalled for a “foreign substance”

• Will: “Ophthalmology offices like my own and pharmacies should check their stock and patients should check any old bottles in the medicine cabinet.” [05:53]

- Havana Syndrome Compensation

[06:06 – 06:41]

• US government issued almost $3 million to personnel affected by the so-called “Havana Syndrome.”
• Symptoms: headaches, hearing problems, dizziness, cognitive symptoms—still poorly understood.
• Adam: “Its cause remains disputed and poorly understood.” [06:34]

- Expanding Cyclospora Outbreak

[06:41 – 07:03]

• Cyclospora (a parasite) outbreak has hit Taco Bell—produce pulled from affected locations.
• Will: “Taco Bell has pulled some fresh produce items from certain locations while investigators continue to look for the source…” [06:48]

- Medical Drama 'The Pit' Dominates Emmy Nominations

[07:03 – 07:47]

• HBO Max series set in a Pittsburgh ER nabbed 25 nominations
• Notable: Noah Wyle’s lead actor nomination, robust ensemble recognition
• “I still can’t believe medical professionals get off shift, go home, and unwind by watching other medical professionals desperately try to get off shift.” (Will, 07:35)
• “Doctors are a special breed, Will.” (Adam, 07:44)

4. Takeaway Reminders

[07:47 – 07:59]

• Will: “Check your eye drops. Do not ignore weird neurologic symptoms. Be careful with fresh produce. And apparently never underestimate Noah Wylie in a hospital…” [07:47]

---

Notable Quotes & Memorable Moments

• On Aspirin Study:
  “Non-inferiority trials sometimes confuse people and this is a good example of one where it’s not saying aspirin is better… but it might be just non inferior.”
  — Will [02:41]

• On Endometriosis Testing:
  “If the tests perform well in practice, they could help patients get treatment earlier, avoid diagnostic laparoscopy in some cases and free up surgical slots for patients who still need them.”
  — Will [04:42]

• Cyclospora/Taco Bell:
  Adam: “I feel like there’s a Taco Bell joke here. It might be a low hanging fruit. Actually, the closest thing they have to fruit is Baja Blast, so I think we’re safe.” [07:03]

• Medical Shows:
  Will: “It doesn’t make sense to me.” [07:35]
  Adam: “Doctors are a special breed, Will.” [07:44]

---

Important Timestamps

• [00:51 – 03:19]: Aspirin vs. Blood Thinners trial discussion
• [03:19 – 05:21]: Rapid endometriosis tests and UK NICE update
• [05:22 – 07:59]: “Off the Clock” quick hits (FDA recall, Havana Syndrome, cyclospora, The Pit and Emmy nods)
• [08:19 – 09:01]: Medical trivia answer (“triage” comes from the French word for “to sort”)

---

Tone and Language

The hosts maintain a collegial, witty, and fact-driven style throughout. Banter lightens the delivery (“You didn’t think we were getting through this without talking about eye drops, did you?” [05:30]), but clinical implications always come back to the fore. The language favors clarity, directness, and the inside-joke familiarity of health professionals.

---

Summary Takeaway

This week’s Medlines episode unpacks major news from aspirin’s reaffirmed role post-arthroplasty to a breakthrough in endometriosis diagnostics, while reminding listeners to check their eye drops, beware produce-linked outbreaks, and celebrate medical TV at its finest. For the always-busy clinician, it’s a quick yet substantive pulse on what matters this week.

Transcript

[A]

Welcome to Medlines, your weekly resource for quick, credible on the go medical news for those of us too busy practicing to remember where we left our hospital badge brought to you by the New

[B]

England Journal of Medicine today is July 17, 2026. At the desk today, bringing you the latest headlines in healthcare. I'm Adam rose.

[A]

And I'm Dr. Will Flannery. Over the last week, a major New England Journal of Medicine trial tested whether aspirin alone is enough to prevent blood clots. Nice moved forward with two rapid endometriosis tests and medical drama. The pit dominated Emmy nominations. This and much more coming up.

[B]

But before we begin, today's trivia question. What emergency medical practice takes its name from the French word meaning to sort?

[A]

Oh, I wish I knew French. That's a good one. Stick around. We'll find out the answer at the end. And now, this week's medlines. Our first story is about a very common post op question. After elective hip or knee replacement, how much blood thinner does a standard risk patient really need? We all know patients are at risk for venous clots after surgery, but stronger anticoagulation can also mean more bleeding, higher costs and a more complicated recovery plan. In the New England Journal of Medicine, EPCAT 3 tested a simpler approach, aspirin alone. From day one, the trial randomized 5,429 patients undergoing elective hip or knee replacement. The comparison was aspirin monotherapy versus 5 days of rivaroxaban followed by aspirin. Patients stayed on prophylaxis for 14 days after knee replacement and 35 days after hip replacement. The main clotting outcome was proximal DVT or pulmonary embolism. Clot rates were nearly identical, 0.48% with aspirin alone versus 0.45% with rivaroxaban followed by aspirin with event rates. So similar authors could label aspirin as non inferior to the rivaroxaban control.

[B]

Aspirin may also offer an advantage in bleeding risk. Wound bleeding requiring reoperation occurred in four patients who began treatment with rivaroxaban and none who received aspirin alone. In routine orthopedic care, that could mean a familiar lower cost option without an initial course of a doac. The findings apply most directly to standard risk joint replacement patients. More than 96% of participants were standard risk on the Stop VTE model. The authors caution that patients with higher risk features, including prior VT, elder age, BMI above 35, or cancer, still need individual consideration for standard risk elective hip and knee arthroplasty patients. Low dose aspirin treatment may be enough.

[A]

Non inferiority trials sometimes confuse people and this is a good example of one where it's not saying aspirin is better than the alternative, but it might be just non inferior. It's just as good and so okay as far as the standard of care goes.

[B]

Well, it's nice that it's such an accessible drug like aspirin, so familiar to so many patients, and avoids a word that terrifies me as a patient reoperation.

[A]

I know orthopedic surgeons are all high fiving somewhere about this, but that's a pretty good week for one very old drug. It may be a big week for two new tests Trying to shorten the diagnostic road

[B]

Our second story is about endometriosis and a possible shortcut through one of the longest diagnostic delays in medicine. Nice the National Institute for Health and Care Excellence has issued draft guidance recommending two rapid tests that could be used by the NHS in England and Wales. The tests are called Endosure and Endotest. The goal is to avoid surgery by identifying endometriosis earlier because right now diagnosis is so slow. In the UK the average delay is now more than nine years. For ethnically diverse women, it's worse about 11 years. During that time, patients may cycle through years of pelvic pain, heavy bleeding, bowel or bladder symptoms and fertility concerns. Many women have repeated appointments, normal imaging and years without a clear diagnosis.

[A]

The two tests work in very different ways. Endotest is a saliva test. It looks for microrna biomarkers in a lab sample. Endosure uses sensor pads on the abdomen after a six to eight hour fast. Those pads measure gut electrical signals with results in about 45 minutes. The tests are meant for patients with suspected endometriosis after initial evaluation and imaging are inconclusive. NICE is allowing use for three years while more real world evidence is gathered. A third test, dotendo, was not approved yet because more research is needed. Still, clinicians and advocates are calling the decision a potential game changer. If the tests perform well in practice, they could help patients get treatment earlier, avoid diagnostic laparoscopy in some cases and free up surgical slots for patients who still need them. Endometriosis UK cautioned that faster testing only helps if patients are recognized early and referred appropriately. What a welcome innovation for people with a very difficult diagnosis, difficult to diagnose, difficult to treat well.

[B]

I think many of us have heard plenty about endometriosis over the years, but what had surprised me in preparing for this week's episode was that it's about 1 in 10 reproductive age women who suffer from endometriosis. So this really means a lot for a lot of people. Very significant in that regard.

[A]

Absolutely.

[B]

All right, well, to wrap things up, we're hitting you with the TLDRs that you and we should have on our radar going into the weekend.

[A]

This is off the clock. First up, something close to my heart eye drops. You didn't think we were getting through this without talking about eye drops, did you? The FDA announced a Class 2 recall of more than 2.5 million bottles of generic prednisolone acetate ophthalmic solution made by Lupin. The recall notice cites the presence of a foreign substance. Prednisolone acetate drops are commonly used after eye surgery and for inflammatory eye conditions. I use it all the. So ophthalmology offices like my own and pharmacies should check their stock and patients should check any old bottles in the medicine cabinet.

[B]

Well, you're the ophthalmologist, but if eye drops are close to your heart, I think you might be applying them incorrectly. The US Government has made its first compensation payments under the Havana Act. The Payments total nearly $3 million for affected personnel with injuries associated with so called Havana syndrome. Havana syndrome is the name given to a cluster of unexplained symptoms first reported by US Personnel overseas. They include headaches, dizziness, hearing problems, cognitive symptoms, and balance issues. The condition has been reported by diplomats, intelligence officers, and other government personnel, but its cause remains disputed and poorly understood.

[A]

The cyclospora outbreak is expanding. Adam, last week we talked about the parasite spreading across multiple states. Well, now the outbreak response has reached restaurant operations, pretty much worst case scenario. Taco Bell has pulled some fresh produce items from certain locations while investigators continue to look for the source of the contaminated products.

[B]

I feel like there's a Taco Bell joke here. It might be a low hanging fruit. Actually, the closest thing they have to fruit is Baja Blast, so I think we're safe. All right. Finally, the Pit is having a very good week with Emmy voters. The HBO Max medical drama set inside an emergency department of a fictional Pittsburgh hospital has each season follow one long shift in near real time. The pit led the 2026 Emmy nominations with 25 nods. Noah Wiley was nominated again for lead actor, and the ensemble picked up a wave of supporting and guest acting nominations.

[A]

I still can't believe medical professionals get off shift, go home, and unwind by watching other medical professionals desperately try to get off shift. It doesn't make sense to me.

[B]

Doctors are a special breed, Will.

[A]

It's a great show, though. Great show.

[B]

Today's off the clock reminder is check your eye drops. Do not ignore weird neurologic symptoms. Be careful with fresh produce. And apparently never underestimate Noah Wylie in a hospital, his mom, by the way,

[A]

an or nurse, and somewhere right now, a former diplomat is checking their eye drops, skipping the lettuce on their crunch wrap and settling in for some HBO Max.

[B]

I'm glad we could be there for them.

[A]

And that wraps up another great week in medicine. Stick around. We'll be right back with the answer to this week's trivia question.

[B]

Before we go, here is today's trivia question. One more time. What emergency medical practice takes its name from the French word meaning to sort of?

[A]

Adam, I gotta say, I have no idea. Do you know. Do you know any French?

[B]

I studied Latin and Spanish. Never took any French. But this one I think might be a little bit of a gimme. I think it's a common enough word. You know, July means new residents. And so just like on the pit. So I think they're making it easy for me. This being my first episode. I'm gonna go with triage.

[A]

That's as good of a guess as I could come up with. So let's go with triage producers. The answer is triage. Yes, the word comes from the French Trier meeting to sort. You're almost a dog, Dr. Adam. There you go.

[B]

One episode at a time.

[A]

In medicine, triage is the process of sorting patients by urgency, especially in emergency departments, disasters and battlefield medicine. Lots of French words have crept in to the medical lexicon.

[B]

I think Latin, I think Greek. I don't think that much French, but it makes sense on this one.

[A]

How about debris? Mon debrisment.

[B]

Easy for you to say. Well, thanks for listening to this week's Medlines. I'm Adam rose.

[A]

And I'm Dr. Will Flanery. Next week at the desk, we'll have our fantastic anchors, Dr. Alok Patel and Eva Johnson. That's right. I'm not going to be here next week, but I'll be back. I'm not going anywhere. And guess what? Adam Rose is going to be back, too.

[B]

Right, Adam, I'll see you in two weeks. Well, if you want, we have a cot in the podcast studio that you can sleep on. Thank you.

[A]

Thank goodness. A big thank you to the New England Journal of Medicine for sponsoring today's episode.

[B]

To learn more about their research and discoveries, visit nejm.com if you want to learn more about any of today's stories, sources and media attribution can be found for this and all episodes on medlinespod.com

[A]

love what we're doing and want to support medical journalism like Medlines? Please share today's episode or the show with your colleagues and friends. This is the place for healthcare professionals to stay up to date on the go and shows like this live or die by word of mouth.

[B]

And now the part where we remind you that listening to a podcast does not establish a doctor patient relationship with

[A]

either of us, especially me. My malpractice carrier still thinks this is just a sketch. Medlines is a news and commentary podcast and is not intended as individualized medical advice. The views news and media shared on this program do not reflect the views of our team, sponsors or any affiliated parties. To review our complete program disclaimer and ethics policy verification and licensing terms and HIPAA release terms, visit medlinespod.com Legal Medlines

[B]

is a human content product.