Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Medicine changes its mind. Expiry catches it.

Ten treatments once standard of care, reversed by pivotal trials. Now in one place.

10 / 10known reversals re-discoveredScan a patient cohort
CardiologyHigh

Aspirin for primary CVD prevention

Was

Routine low-dose aspirin for primary prevention in adults 50-59 years with >= 10% 10-year ASCVD risk (USPSTF, 2016).

Now

USPSTF (2022): Grade D against initiating aspirin for primary prevention in adults >= 60 years. Grade C (individualized decision) for adults 40-59 years with >= 10% ASCVD risk.

ASPREE2018

Increased major hemorrhage (HR 1.38; 95% CI 1.18-1.62) and higher all-cause mortality (5.9% vs. 5.7%) in elderly patients, with no CVD benefit.

EndocrinologyHigh

Hormone therapy for chronic disease prevention

Was

Estrogen or combined estrogen/progestin hormone therapy widely prescribed for cardioprotection and chronic disease prevention (Pre-2002 consensus).

Now

USPSTF (2022): Grade D recommendation against the use of systemic combined estrogen/progestin or estrogen alone for the primary prevention of chronic conditions.

WHI2002

Combined CEE+MPA increased CHD (HR 1.18), stroke (HR 1.31), and invasive breast cancer (HR 1.26; 95% CI 1.00-1.59). Estrogen alone increased stroke risk without CHD benefit.

EndocrinologyHigh

Intensive glucose control in Type 2 diabetes

Was

Universal tight glycemic control targeting HbA1c < 7.0% or < 6.0% for macrovascular risk reduction (ADA, pre-2008).

Now

ADA (Current Standards of Care): Individualized HbA1c goals. Generally < 7.0%, but less stringent targets (< 8.0%) strictly recommended for older adults with extensive comorbidities or high hypoglycemic risk.

ACCORD2008

Intensive target (< 6.0%) increased all-cause mortality (HR 1.22; 95% CI 1.01-1.46) and cardiovascular mortality (HR 1.35; 95% CI 1.04-1.76) compared to standard control (7.0-7.9%).

OncologyCritical

PSA screening in men aged 70+

Was

Routine annual PSA screening for all men beginning at age 50 (ACS/AUA early 2000s).

Now

USPSTF (2018): Grade C (individualized shared decision) for men aged 55-69. Grade D (do not screen) for men >= 70 years.

ERSPC/PLCO2009

High rates of overdiagnosis (20-50%); minimal absolute mortality reduction (1.3 deaths prevented per 1,000 screened); severe treatment morbidity (incontinence, erectile dysfunction).

CardiologyCritical

Class 1C antiarrhythmics post-myocardial infarction

Was

Routine use of Class 1C antiarrhythmics to suppress PVCs following myocardial infarction to prevent sudden death (Pre-1989 standard of care).

Now

ACC/AHA guidelines: Absolute contraindication for Class 1C antiarrhythmics (flecainide, encainide) in patients with prior MI or structural heart disease.

CAST1989

Flecainide and Encainide increased cardiovascular mortality risk 2.5 times (RR 2.5; 95% CI 1.7-8.5) compared to placebo.

CardiologyModerate

Routine PCI for stable coronary artery disease

Was

Routine PCI and stenting for significant angiographic stenoses (> 70%) in stable CAD to prevent death and myocardial infarction (Pre-2007 consensus).

Now

ACC/AHA Guidelines: Optimal medical therapy (OMT) is the primary management strategy for stable ischemic heart disease. PCI is indicated strictly for refractory anginal symptom relief, not mortality reduction.

COURAGE2007

PCI + OMT showed no difference in all-cause death or nonfatal MI compared to OMT alone (19.0% vs. 18.5%, p=NS).

CardiologyModerate

Supplemental oxygen in normoxemic acute MI

Was

Universal administration of high-flow supplemental oxygen to all patients with suspected acute myocardial infarction, regardless of baseline saturation.

Now

ESC/ACC/AHA Guidelines (2017): Supplemental oxygen is indicated only if the patient presents with frank hypoxemia (arterial oxygen saturation < 90%).

DETO2X-AMI2017

No reduction in 1-year all-cause mortality (5.0% vs. 5.1%, HR 0.97, p=NS) or rehospitalization with routine oxygen in normoxemic MI patients.

Perioperative MedicineHigh

Perioperative beta-blockers for noncardiac surgery

Was

Routine, acute initiation of beta-blockers immediately prior to noncardiac surgery in patients at risk for cardiovascular events to prevent perioperative MI.

Now

2014 ACC/AHA Guidelines: Routine acute initiation of beta-blockers on the day of surgery in beta-blocker-naive patients is strictly not recommended.

POISE2008

Metoprolol reduced MI but doubled stroke risk (HR 2.17; 95% CI 1.26-3.74) and increased all-cause mortality (HR 1.33; 95% CI 1.03-1.74) due to hypotension and bradycardia.

OrthopedicsModerate

Arthroscopic partial meniscectomy for degenerative knee OA

Was

Routine arthroscopic debridement and partial meniscectomy for pain relief in degenerative knee osteoarthritis.

Now

AAOS Guidelines: Non-operative management (physical therapy, NSAIDs, weight loss) is strongly recommended over arthroscopy for patients with degenerative meniscal tears and OA.

Moseley2002

Sham-controlled surgery showed no benefit over placebo or physical therapy in pain or functional outcomes at 2 years.

NephrologyModerate

Renal artery stenting for atherosclerotic renal artery stenosis

Was

Routine angioplasty and stenting for significant atherosclerotic renal artery stenosis to treat refractory hypertension and preserve kidney function.

Now

ACC/AHA Guidelines: Comprehensive medical therapy is the foundational treatment. Stenting provides no incremental benefit over medical therapy for most patients.

CORAL2014

Renal artery stenting added to medical therapy yielded no significant difference in CV/renal events (35.1% vs. 35.8%, HR 0.94; 95% CI 0.76-1.17) compared to medical therapy alone.