NEJM This Week — April 16, 2026

This week's episode of NEJM This Week explores groundbreaking research and critical perspectives across multiple domains of clinical medicine and public health. Key studies include a phase 3 trial showing that asundexion, an activated factor XI inhibitor, significantly reduces recurrent ischemic stroke and major cardiovascular events in patients with non-cardioembolic stroke or TIA, without increasing major bleeding risk—marking a potential breakthrough in secondary stroke prevention. Conversely, a large international trial found no benefit of adjunctive prednisolone in reducing coronary artery lesions in Kawasaki disease, reinforcing current guidelines against routine glucocorticoid use. Another major trial, SIDICU, found no mortality benefit from selective decontamination of the digestive tract in ICU patients on mechanical ventilation, though it reduced bloodstream and resistant infections—raising important questions about long-term antibiotic resistance and clinical implementation. The episode also highlights a case of undiagnosed narcolepsy type 1 in a young man initially misattributed to psychiatric illness, underscoring the need for better recognition of central hypersomnolence disorders. In broader policy discussions, perspectives examine the risks of hormone therapy on thrombotic and cardiovascular health, the threat of student loan policy changes to the nursing workforce, the underutilization of nurse scientists in health communication despite their high public trust, and the severe health consequences of environmental regulatory rollbacks under the second Trump administration. These themes collectively emphasize the importance of evidence-based medicine, health equity, and the restoration of public trust in science and healthcare systems.