scholarly journals A Systematic Review of the Risks and Benefits of Venous Thromboembolism Prophylaxis in Traumatic Brain Injury

2018 ◽  
Vol 45 (4) ◽  
pp. 432-444 ◽  
Author(s):  
Joseph Margolick ◽  
Charlotte Dandurand ◽  
Katrina Duncan ◽  
Wenjia Chen ◽  
David C. Evans ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Regression Analysis ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Intracranial Hemorrhage ◽  
Hematoma Expansion ◽  
Increased Risk ◽  
Meta Regression ◽  
Meta Regression Analysis

AbstractBackground:Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of pharmacological venous thromboprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the postinjury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion.Methods:MEDLINE and EMBASE databases were searched. Inclusion criteria were studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers’ levels of evidence. Randomized controlled trials were assessed for bias according to the Cochrane Collaboration Tool and Cohort studies were evaluated for bias using the Newcastle-Ottawa Scale. We performed univariate meta-regression analysis in an attempt to identify a relationship between VTEp timing and hemorrhagic progression and assess study heterogeneity using anI2statistic.Results:Twenty-one studies were included in the systematic review. Eighteen total studies demonstrated that VTEp postinjury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration 24 to 72 hours postinjury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive intracranial hemorrhage. Overall, meta-regression analysis demonstrated that there was no relationship between rate of hemorrhagic progression and VTEp timing.Conclusions:Literature suggests that administering VTEp 24 to 48 hours postinjury may be safe for patients with low-hemorrhagic-risk TBIs and stable injury on repeat imaging.

scholarly journals P.090 A systematic review of the risks and benefits of venous thromboembolism prophylaxis in traumatic brain injury

2016 ◽  
Vol 43 (S2) ◽  
pp. S41-S41
Author(s):  
C Dandurand ◽  
J Margolick ◽  
D Evans ◽  
M Sekhon ◽  
N Garraway ◽  
...  
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Venous Thromboembolism ◽  
Brain Injury ◽  
Hematoma Expansion ◽  
Time Interval ◽  
Thromboembolism Prophylaxis ◽  
Post Injury ◽  
Increased Risk ◽  
Hemorrhagic Risk

Background: Patients suffering from traumatic brain injury (TBI) are at increased risk of venous thromboembolism (VTE). However, initiation of chemoprophylaxis (VTEp) may cause further intracranial hemorrhage. We reviewed the literature to determine the post-injury time interval at which VTEp can be administered without risk of TBI evolution and hematoma expansion. Methods: MEDLINE and EMBASE databases were searched. Inclusion criteria were: studies investigating timing and safety of VTEp in TBI patients not previously on oral anticoagulation. Two investigators extracted data and graded the papers based on levels of evidence. Results: A total of 408 studies were screened. Forty-five studies were reviewed in-entirety and 21 were included in the systematic review. There were 2 prospective randomized trials and 19 comparative studies. Eighteen total studies demonstrated that VTEp post injury in patients with stable head computed tomography scan does not lead to TBI progression. Fourteen studies demonstrated that VTEp administration specifically 24–72 hours post injury is safe in patients with stable injury. Four studies suggested that administering VTEp within 24 hours of injury in patients with stable TBI does not lead to progressive ICH. Conclusions: Literature suggests that administering VTEp 48 hours post-injury may be safe for patients with low-hemorrhagic risk TBIs and stable injury on repeat imaging.

scholarly journals Effect of tranexamic acid on thrombotic events and seizures in bleeding patients: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Shuhei Murao ◽  
Hidekazu Nakata ◽  
Ian Roberts ◽  
Kazuma Yamakawa
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Venous Thromboembolism ◽  
Tranexamic Acid ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Background Tranexamic acid (TXA) reduces surgical bleeding and reduces death from bleeding after trauma and childbirth. However, its effects on thrombotic events and seizures are less clear. We conducted a systematic review and meta-analysis to examine the safety of TXA in bleeding patients. Methods For this systematic review and meta-analysis, we searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled trials from inception until June 1, 2020. We included randomized trials comparing intravenous tranexamic acid and placebo or no intervention in bleeding patients. The primary outcomes were thrombotic events, venous thromboembolism, acute coronary syndrome, stroke and seizures. A meta-analysis was performed using a random effects model and meta-regression analysis was performed to evaluate how effects vary by dose. We assessed the certainty of evidence using the grading of recommendations, assessment, development and evaluations (GRADE) approach. Results A total of 234 studies with 102,681 patients were included in the meta-analysis. In bleeding patients, there was no evidence that TXA increased the risk of thrombotic events (RR = 1.00 [95% CI 0.93–1.08]), seizures (1.18 [0.91–1.53]), venous thromboembolism (1.04 [0.92–1.17]), acute coronary syndrome (0.88 [0.78–1.00]) or stroke (1.12 [0.98–1.27]). In a dose-by-dose sensitivity analysis, seizures were increased in patients receiving more than 2 g/day of TXA (3.05 [1.01–9.20]). Meta-regression showed an increased risk of seizures with increased dose of TXA (p = 0.011). Conclusion Tranexamic acid did not appear to increase the risk of thrombotic events in bleeding patients. However, because there may be dose-dependent increase in the risk of seizures, very high doses should be avoided.

scholarly journals Temporal trends in sperm count: a systematic review and meta-regression analysis

2017 ◽  
Vol 23 (6) ◽  
pp. 646-659 ◽  
Author(s):  
Hagai Levine ◽  
Niels Jørgensen ◽  
Anderson Martino-Andrade ◽  
Jaime Mendiola ◽  
Dan Weksler-Derri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Sperm Count ◽  
Temporal Trends ◽  
Meta Regression ◽  
Meta Regression Analysis

scholarly journals Effect Modification by Age on the Benefit or Harm of Antihypertensive Treatment for Elderly Hypertensives: A Systematic Review and Meta-analysis

2018 ◽  
Vol 32 (2) ◽  
pp. 163-174 ◽  
Author(s):  
Chi-Jung Huang ◽  
Chern-En Chiang ◽  
Bryan Williams ◽  
Kazuomi Kario ◽  
Shih-Hsien Sung ◽  
...  
Keyword(s):  
Renal Failure ◽  
Regression Analysis ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Effect Modification ◽  
Close Monitoring ◽  
Increased Risk ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
Elderly Hypertensives

Abstract BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140–150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55–0.85), HF (0.77; 0.60–0.99), cardiovascular death (0.68; 0.52–0.89), and MACE (0.83; 0.69–0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.

scholarly journals Long-term manifestations and modifiers of prevalence estimates of the post-COVID-19 syndrome: A systematic review and meta-analysis.

2021 ◽  
Author(s):  
Daniel De-la-Rosa-Martínez ◽  
Marco Antonio Delaye-Martínez ◽  
Omar Yaxmehen Bello-Chavolla ◽  
Alejandro Sicilia-Andrade ◽  
Isaac David Juárez-Cruz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Meta Analysis ◽  
Population Characteristics ◽  
Published Data ◽  
System Disease ◽  
Prevalence Estimates ◽  
Meta Regression ◽  
Meta Regression Analysis

Background: Post-acute COVID-19 syndrome (PACS) is a multi-system disease comprising persistent symptomatology after the acute phase of infection. Long-term PACS effects significantly impact patient outcomes, but their incidence remains uncharacterized due to high heterogeneity between studies. Therefore, we aimed to summarize published data on PACS, characterizing the clinical presentation, prevalence, and modifiers of prevalence estimates. Method: In this systematic review and meta-analysis, we research MEDLINE for original studies published from January 1st, 2020, to January 31st, 2021, that reported proportions of PACS manifestations. Studies were eligible for inclusion if they included patients aged ≥18 years with confirmed COVID-19 by RT-PCR or antigen testing and a minimum follow-up of 21 days. The prevalence of individual manifestations across studies was pooled using random-effects meta-analysis. For evaluating determinants of heterogeneity, meta-regression analysis was performed. This study was registered in PROSPERO (CRD42019125025). Results: After screening 1,235 studies, we included 29 reports for analysis. Twenty-seven meta-analyses were performed, and 61 long-term manifestations were described. The pooled prevalence of PACS was 56% (95%CI 45-66%), with the most common manifestations being diminished health status, fatigue, asthenia, dyspnea, myalgias, hyposmia and dysgeusia. Most of the included studies presented high heterogeneity. After conducting the meta-regression analysis, we identified that age, gender, number of comorbidities, and reported symptoms significantly modify the prevalence estimation of PACS long-term manifestations. Conclusion: PACS is inconsistently reported between studies, and population characteristics influence the prevalence estimates due to high heterogeneity. A systematized approach for the study of PACS is needed to characterize its impact adequately.

Systematic review and meta-regression analysis of technical efficiency in dairy farms

2016 ◽  
Vol 65 (3) ◽  
pp. 279-301 ◽  
Author(s):  
Taciana Mareth ◽  
Antonio Marcio Tavares Thomé ◽  
Fernando Luiz Cyrino Oliveira ◽  
Luiz Felipe Scavarda
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Technical Efficiency ◽  
Geographical Location ◽  
Dairy Farms ◽  
Two Dimensions ◽  
Farm Size ◽  
Content Type ◽  
Meta Regression ◽  
Meta Regression Analysis

Purpose – The purpose of this paper is to complement and extend previous literature reviews on Technical Efficiency (TE) in dairy farms, analysing the effects of different methodologies and study-specific characteristics on Mean TE (MTE). Design/methodology/approach – The researchers independently conducted a systematic review of more than 400 abstracts and 85 full-text papers. Original keywords were applied to seven key electronic databases. Results from a meta-regression analysis of 85 published papers totalling 443 TE distributions in dairy farms worldwide are discussed. Findings – The variation in the MTE indexes reported in the literature can be explained by the methodology of estimations (method of estimation, functional form of frontier models, model dimensionality), the farms geographical location and farm size. Additionally, the results suggest that, given the state of technology prevailing in each country at the time that the studies on TE were conducted, dairy farmers in the sample could increase milk output by 20.9 per cent (level of inefficiency), on average, if they produce on their frontiers. Originality/value – This study makes two important contributions: first, it updates and compares previous works on frontier estimation of TE in dairy farms; and second, it adds two dimensions of dairy farms, size (herd and land area) and economic development, to the known differentials of TE measurement.

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