Evidence Rounds

In a double-blind RCT of 108 obese AUD pts motivated for sobriety, semaglutide reduced heavy drinking days by 13% (absolute) vs placebo Reduction in drinking strongly correlated w/ weight los Suggests shared mechanism or functional unblinding, which might exaggerate benefits

Treating addiction is hard In a pragmatic RCT of patients with nonfatal opioid overdose, ED peer navigators did not reduce 1-year outcomes This builds on a prior step-wedge cluster RCT: addiction consult increased med use, but 6-month retention was low & similar (2.4% vs 3.2%)

Mild predialysis hyperkalemia may not warrant treatment Among ESRD patients with a pre-dialysis K≥5.5, Lokelma improved long-term potassium control but did NOT reduce arrhythmia-related cardiovascular events (8.8% vs 8.9%) The trial was stopped early for low event rates

Up to 40% of hospitalized adults discharge to post-acute care at home or in a facility This review demystifies post-acute care with a practical framework to match the right setting to a patient’s needs and plan for a smoother transition

Consider single-dose amphotericin for cryptococcal meningitis In a US safety-net hospital, the AMBITION regimen established in LMICs (single-dose liposomal ampho+flucy/fluc) achieved same outcomes with fewer severe adverse events in a pre-post analysis vs standard 14-day course

A 2023 narrative review challenges the centrality of dual-process models, arguing that diagnostic expertise matters more Improving clinical reasoning may depend less on debiasing & more on richer problem representations, illness scripts & better access to the right knowledge

Age-adjusted d-dimer cutoffs can safely exclude DVT A multicenter prospective cohort found that 7% of imaging could be avoided by using this strategy over the standard d-dimer cutoffs

Prebiopsy steroids don’t reduce diagnostic yield in lymphoma (DLBCL) A retrospective study confirmed biopsy type mattered most for yield (excisional > core >>> FNA)

Aspirin’s decline continues In high-risk stable CAD patients already on anticoagulation (all post-PCI, 70% with prior MI; mostly on DOACs for Afib), adding aspirin increased death, CV events, and major bleeding in a multicenter trial, prompting early termination

For provoked VTE, standard therapy is 3 months, but what about patients with ongoing risk (ie autoimmune disease, obesity)? In a single-center RCT, extended low-dose apixaban (2.5mg BID) reduced recurrent VTE vs placebo at 1 year (HR 0.13, NNT=10), with KM curves still diverging

Is GDMT for heart failure coming full circle? In a double-blind multicenter trial of advanced HFrEF, digitoxin—a safer digoxin analog not available in the US—reduced both mortality and hospitalizations A Dutch trial of digoxin is underway, with results expected soon

Conservative dialysis strategy shows promise for AKI-D The LIBERATE-D trial found that this approach led to better renal recovery at discharge vs thrice-weekly dialysis (64% vs 50%) Although adjusted CIs were nonsignificant and deaths were numerically higher

A meta-analysis of 5 contemporary trials found no improvement in outcomes with beta blocker therapy after myocardial infarction with normal EF (≥50%)

Is less always more? In an RCT of older nursing home residents with controlled HTN (mean age 90, MMSE 13, ~40% severely frail), deprescribing antihypertensives neither helped or harmed Yet, still warrants consideration to stop BP meds for patients with limited life expectancies

Starting in 2026, California will sell a 5-pack of glargine insulin pens for $55, about half the ~$100 GoodRx price, through its state-subsidized CalRx program Whether this price can be sustained without ongoing subsidies is to be determined

Tranexamic acid should be considered for patients undergoing noncardiac surgery at risk of bleeding In a multicenter double-blinded RCT, periop tranexamic acid (1g IV before & after) reduced major bleeding by 24% (ARR 2.6%, NNT 38) without increasing cardiovascular events