Join us on November 5th, 2025, from 4-5 pm for a free crash course on acute kidney injury.
Speaker details: Dr. Mike Fralick is a Clinician Scientist who works in Toronto and Sault Ste. Marie.
For patients with stroke and atrial fibrillation, is adding aspirin a bad idea?
Optimal Antithrombotics for Ischemic Stroke and Concurrent Atrial Fibrillation and Atherosclerosis
Okazaki S et al. JAMA Neurology (October 2025)
Bottom Line: This multicenter, open-label randomized clinical trial was conducted across 41 sites in Japan from November 2016 to March 2025, involving 316 patients with ischemic stroke or transient ischemic attack, nonvalvular atrial fibrillation, and atherosclerotic cardiovascular disease. Participants were randomized to receive either combination therapy (anticoagulant plus antiplatelet) or anticoagulant monotherapy. The trial was terminated on July 18, 2023, after an interim analysis for futility. The primary outcome, a composite of ischemic cardiovascular events and major bleeding within 2 years, showed 17.8% in the combination group and 19.6% in the monotherapy group (hazard ratio [HR], 0.91; 95% CI, 0.53-1.55; P = .64). Ischemic cardiovascular events occurred in 11.1% and 14.2% (HR, 0.76; 95% CI, 0.39-1.48; P = .41), and major and clinically relevant nonmajor bleeding occurred in 19.5% and 8.6% (HR, 2.42; 95% CI, 1.23-4.76; P = .008) of combination therapy and monotherapy groups, respectively. The trial concluded that adding an antiplatelet agent to anticoagulant therapy did not provide a net clinical benefit and increased bleeding risk.
Do we really have to give octreotide for 5 days for esophageal bleeding?
One versus five days of octreotide infusion for acute esophageal variceal bleeding
Chirapongsathorn S et al. The American Journal of Gastroenterology (October 2025)
Bottom line: This nationwide, multicenter, non-inferiority, open-label, randomized, controlled trial evaluated the efficacy of 1-day versus 5-day octreotide infusion for preventing re-bleeding in 220 patients with cirrhosis and acute esophageal variceal bleeding who underwent endoscopic band ligation. The primary outcome was early re-bleeding within 5 days, with results showing 1.83% in the 1-day group and 1.80% in the 5-day group (p≥0.99), demonstrating non-inferiority (event-rate difference of 0.03%, 95% CI, 3.50-3.56%). Safety outcomes indicated fewer blood transfusions and shorter hospital stays for the 1-day group. The study concludes that the 1-day regimen is non-inferior to the standard 5-day regimen in this clinical context.
Does semaglutide reduce alcohol consumption in adults with alcohol use disorder?
Once-Weekly Semaglutide in Adults With Alcohol Use Disorder
Hendershot C.S et al. JAMA Psychiatry (February 2025)
Bottom Line: This randomized, double-blind, placebo-controlled phase 2 trial evaluated the efficacy and safety of semaglutide in adults with alcohol use disorder (AUD). 48 non–treatment-seeking participants with AUD were randomly assigned in a 1:1 ratio to receive semaglutide (0.25 mg/week for 4 weeks, 0.5 mg/week for 4 weeks, and 1.0 mg for 1 week) or placebo for 9 weeks. The primary outcome was laboratory alcohol self-administration, measured at pretreatment and posttreatment (0.5 mg/week). Semaglutide significantly reduced grams of alcohol consumed and peak breath alcohol concentration compared with placebo. The findings suggest that low-dose semaglutide may reduce alcohol intake and craving, supporting further investigation of GLP-1 receptor agonists for the treatment of AUD.
Trial Files Issue #2025-22