Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: A systematic review and meta-analysis of randomized trials

2009 ◽  
Vol 157 (1) ◽  
pp. 132-140 ◽  
Author(s):  
Sanjit S. Jolly ◽  
Shoaib Amlani ◽  
Martial Hamon ◽  
Salim Yusuf ◽  
Shamir R. Mehta
Keyword(s):  
Systematic Review ◽  
Coronary Angiography ◽  
Major Bleeding ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Femoral Access ◽  
The Impact ◽  
Ischemic Events

scholarly journals Radial versus femoral access for coronary angiography and interventions: a systematic review and meta-analysis of randomized trials

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Chiarito ◽  
D Cao ◽  
J Nicolas ◽  
A Roumeliotis ◽  
D Power ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Angiography ◽  
Major Bleeding ◽  
Randomized Trials ◽  
Significant Risk ◽  
Number Needed To Treat ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Radial Access ◽  
All Cause Mortality

Abstract Background The presence of any benefits associated with radial or femoral access among patients undergoing coronary angiography and percutaneous coronary interventions (PCI) is still debated. Purpose Our aim is to provide a comprehensive quantitative appraisal of the effects of access site on the risks of stroke, myocardial infarction, and major bleeding in patients undergoing coronary angiography with or without PCI. Methods In January 2020, we searched PubMed, Embase, and meeting abstracts for randomized trials comparing radial versus femoral access for coronary angiography with or without subsequent PCI. Odds ratios (OR) were used as metric of choice for treatment effects with random-effects models. Co-primary efficacy endpoints were stroke and myocardial infarction. Primary safety endpoint was major bleeding. Secondary endpoints were all cause mortality and vascular complications. Heterogeneity was assessed with the I-squared index. This study is registered with PROSPERO. Results We identified 31 trials, including 30,414 patients. Risks of stroke (OR 1.11, 95% CI 0.76–1.64, I2=0%) and myocardial infarction (OR 0.90, 95% CI 0.79–1.03, I2=0%) were comparable between radial and femoral access. Radial access was associated with a reduction for the risk of major bleeding as compared to femoral access (OR 0.53, 95% CI 0.42–0.67, I2=3.3%) with a number needed to treat of 92. Findings were consistent regardless clinical features and procedure performed, with the only exception of an increased benefit of the radial access in patients with chronic coronary syndrome (p forinteraction=0.005). The risk for all-cause mortality (OR 0.73, 95% CI 0.61–0.89, I2=0%) and vascular complication (OR 0.32, 95% CI 0.23–0.44, I2=16.7%) was significantly lower in the radial compared to femoral access group. Conclusions In patients undergoing coronary angiography with or without PCI, radial compared to femoral access did not reduce the risk of stroke and myocardial infarction, with no impact on the effect estimates of clinical presentation, age, gender, or subsequent PCI. Whereas, radial access is associated with a significant risk reduction of major bleeding as compared to femoral access. The benefit favoring radial access is of important clinical relevance in view of the relatively low number needed to treat to prevent a major bleeding and the significant impact on mortality. Funding Acknowledgement Type of funding source: None

Clinical Outcomes in Patients Receiving Venous Thromboembolism (VTE) Prophylaxis after Orthopedic Surgery (OS). A Systematic Review and Meta-Analysis of Proportions.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 626-626
Author(s):  
Alejandro Lazo-Langner ◽  
Douglas Coyle ◽  
Nicholas J. Barrowman ◽  
Tim Ramsay ◽  
Philip S. Wells ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Pulmonary Angiography ◽  
Systematic Evaluation ◽  
Analytical Strategy ◽  
Vte Prophylaxis ◽  
Hip Fracture Surgery

Abstract Major VTE is the most frequent complication of OS. Current recommendations are to administer prophylaxis with an anticoagulant agent for at least 7–10 days. Numerous studies have evaluated different agents for this purpose. Although the most recent studies are usually methodologically sound, several studies have been hampered by inappropriate designs and insufficient sample sizes. In order to help with the design of future trials we conducted a systematic review of randomized trials evaluating short-term (< 15 days) administration of anticoagulants for VTE prophylaxis in OS and performed a MA of simple proportions to estimate the overall incidence of major VTE (proximal VTE, pulmonary embolism (PE), or death from PE), total VTE (proximal and distal VTE, PE or death from PE), and major bleeding episodes (as defined by the authors and defined using a definition similar to the one proposed by the International Society on Thrombosis and Haemostasis-ISTH). We included randomized trials comparing different drugs for VTE prophylaxis in OS (hip and knee arthroplasty and hip fracture surgery) using systematic evaluation of VTE (ultrasound or venography, pulmonary angiography, tomographic angiography, or ventilation perfusion lung scan). Heterogeneity of proportions was evaluated using a chi ² test and pooled estimates of proportions were obtained using a fixed or a random effects model as appropriate. In the latter the weights were estimated as proposed by Laird and Mosteller. We retrieved 55 studies (135 research arms) which enrolled 42,131 patients. The percentage and variance of major and total VTE and major bleeding are shown in table 1. The total number of events and the number of evaluable patients are shown in table 2. We found differences in the percentage of clinical outcomes associated with the use of different agents for VTE prophylaxis after OS, however, because of the analytical strategy used no estimation of odds or risk reduction can be derived from this data. We believe that these estimates will be of help for the design of future studies.

scholarly journals Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 10 (10) ◽  
pp. 2163
Author(s):  
Gani Bajraktari ◽  
Zarife Rexhaj ◽  
Shpend Elezi ◽  
Fjolla Zhubi-Bakija ◽  
Artan Bajraktari ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Clinical Outcome ◽  
Major Bleeding ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Vascular Complications ◽  
Controlled Trials ◽  
Femoral Access ◽  
Randomized Controlled ◽  
Radial Access

Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.

scholarly journals Polypharmacy and health outcomes in atrial fibrillation: a systematic review and meta-analysis

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001257 ◽  
Author(s):  
Celine Gallagher ◽  
Karin Nyfort-Hansen ◽  
Debra Rowett ◽  
Christopher X Wong ◽  
Melissa E Middeldorp ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Health Outcomes ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Total Study Population ◽  
The Impact

ObjectiveTo undertake a systematic review and meta-analysis examining the impact of polypharmacy on health outcomes in atrial fibrillation (AF).Data sourcesPubMed and Embase databases were searched from inception until 31 July 2019. Studies including post hoc analyses of prospective randomised controlled trials or observational design that examined the impact of polypharmacy on clinically significant outcomes in AF including mortality, hospitalisations, stroke, bleeding, falls and quality of life were eligible for inclusion.ResultsA total of six studies were identified from the systematic review, with three studies reporting on common outcomes and used for a meta-analysis. The total study population from the three studies was 33 602 and 37.2% were female. Moderate and severe polypharmacy, defined as 5–9 medicines and >9 medicines, was observed in 42.7% and 20.7% of patients respectively, and was associated with a significant increase in all-cause mortality (Hazard ratio [HR] 1.36, 95% CI 1.20 to 1.54, p<0.001; HR 1.84, 95% CI 1.40 to 2.41, p<0.001, respectively), major bleeding (HR 1.32, 95% CI 1.14 to 1.52, p<0.001; HR 1.68, 95% CI 1.35 to 2.09, p<0.001, respectively) and clinically relevant non-major bleeding (HR 1.12, 95% CI 1.03 to 1.22, p<0.01; HR 1.48, 95% CI 1.33 to 1.64, p<0.01, respectively). There was no statistically significant association between polypharmacy and stroke or systemic embolism or intracranial bleeding. Among other examined outcomes, polypharmacy was associated with cardiovascular death, hospitalisation, reduced quality of life and poorer physical function.ConclusionsPolypharmacy is highly prevalent in the AF population and is associated with numerous adverse outcomes.PROSPERO registration numberCRD42018105298.

scholarly journals The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis

Blood ◽  
2014 ◽  
Vol 124 (15) ◽  
pp. 2450-2458 ◽  
Author(s):  
Chatree Chai-Adisaksopha ◽  
Mark Crowther ◽  
Tetsuya Isayama ◽  
Wendy Lim
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Bleeding ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Bleeding Complications ◽  
Fatal Bleeding ◽  
Increased Risk ◽  
Key Points ◽  
The Impact

Key Points TSOACs are associated with less major bleeding, fatal bleeding, clinically relevant nonmajor bleeding, and total bleeding. The meta-analysis does not show increased risk of major gastrointestinal bleeding in patients who received TSOACs compared with warfarin.

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