The headliner: For patients with MI, liberal transfusion strategy improves outcomes.
For most patients admitted into hospital, the typical threshold for transfusing red blood cells is 70 g/L (7 g/dL) based on the TRICC trial. But what about patients with myocardial infarction? A recent individual patient data meta-analysis of 4311 patients from four randomized trials suggests a more liberal strategy (~100 g/L, 10 g/dL). The primary outcome occurred in 334 patients (15.4%) in the restrictive strategy and 296 patients (13.8%) in the liberal strategy (relative risk [RR] 1.13, 95% confidence interval [CI], 0.97 to 1.30). All-cause mortality at 6 months occurred in 20.5% of patients in the restrictive strategy compared with 19.1% of patients in the liberal strategy (hazard ratio 1.08, 95% CI, 1.05 to 1.11). For me, these results are practice changing, and for a patient with myocardial infarction, I no longer wait until their hemoglobin drops to 70 (or even 80!) before transfusing.
Hidden gem #1: High dose vitamin D reduces risk of MS flare.
While observational data suggests vitamin D cures just about everything, 99% of randomized trials of vitamin D are negative. And here, my friends, is an RCT in the 1% group! The study was conducted in France, 70% of the participants were women, the median age was 34, and all patients had a first presentation with signs and symptoms consistent with MS in the preceding 90 days. Overall, 153 participants received placebo and 163 participants received 100,000 IU of vitamin D every 14 days over 2 years. The primary outcome of an MS flare at 2 years occurred in 74% who received placebo and 60% who received vitamin D (HR=0.66, 95% CI 0.50 to 0.87). While there were no major adverse events with vitamin D, the study was relatively small and requires replication. Small studies, even RCTs, can find positive results from chance alone.
Hidden gem #2: Semaglutide (Ozempic) leads to a reduction in alcohol intake.
Ozempic is a new, up and coming medication that you have probably never heard of ;). A small, single-centre, double-blind RCT has shown that adults with alcohol use disorder randomized to semaglutide drank less alcohol compared to adults randomized to placebo. This aligns with what I (and many others!) have observed in practice. Countless patients tell me that they are not only eating less, but also drinking less. Small studies conducted at single centres are seldom reproducible. However, I’d bet a very expensive bottle of red that this one holds in subsequent studies.
The take home points:
[1] In patients with acute myocardial infarction and anemia, a restrictive transfusion strategy may not reduce short-term mortality or MI risk and is associated with higher all-cause mortality at 6 months compared to a liberal strategy.
[2] For adults with MS, high dose vitamin D (100,000 IU q2weeks) reduced risk of MS flare.
[3] For adults with alcohol use disorder, semaglutide may reduce alcohol intake.