Cryoprecipitate transfusion in bleeding patients

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S4-S11
Author(s):  
Barto Nascimento ◽  
Jerrold H. Levy ◽  
Homer Tien ◽  
Luis Teodoro Da Luz
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Massive Bleeding ◽  
Clinical Settings ◽  
Potential Safety ◽  
Fresh Frozen ◽  
Pathogen Reduction ◽  
Current Guidelines ◽  
Robust Evidence ◽  
Fibrinogen Content

ABSTRACTObjectivesThe management of acquired coagulopathy in multiple clinical settings frequently involves fibrinogen supplementation. Cryoprecipitate, a multidonor product, is widely used for the treatment of acquired hypofibrinogenemia following massive bleeding, but it has been associated with adverse events. We aimed to review the latest evidence on cryoprecipitate for treatment of bleeding.MethodsWe conducted a narrative review of current literature on cryoprecipitate therapy, describing its history, formulations and preparation, and recommended dosing. We also reviewed guideline recommendations on the use of cryoprecipitate in bleeding situations and recent studies on its efficacy and safety.ResultsCryoprecipitate has a relatively high fibrinogen content; however, as it is produced by pooling fresh frozen donor plasma, the fibrinogen content per unit can vary considerably. Current guidelines suggest that cryoprecipitate use should be limited to treating hypofibrinogenemia in patients with clinical bleeding. Until recently, cryoprecipitate was deemed unsuitable for pathogen reduction, and potential safety concerns and lack of standardized fibrinogen content have led to some professional bodies recommending that cryoprecipitate is only indicated for the treatment of bleeding and hypofibrinogenemia in perioperative settings where fibrinogen concentrate is not available. While cryoprecipitate is effective in increasing plasma fibrinogen levels, data on its clinical efficacy are limited.ConclusionsThere is a lack of robust evidence to support the use of cryoprecipitate in bleeding patients, with few prospective, randomized clinical trials performed to date. Clinical trials in bleeding settings are needed to investigate the safety and efficacy of cryoprecipitate and to determine its optimal use and administration.

scholarly journals Cancer-associated thrombosis: updates and controversies

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 626-630 ◽  
Author(s):  
Alok A. Khorana
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Clinical Decision ◽  
Low Molecular Weight ◽  
Clinical Settings ◽  
Level Of Evidence ◽  
Patients With Cancer ◽  
Multiple Biomarkers ◽  
Cancer Associated Thrombosis

Abstract Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. This update will focus on recent findings, including the phenomenon of incidental venous thromboembolism (VTE), novel approaches to risk assessment, and the results of randomized clinical trials focusing on prophylaxis of cancer outpatients. Incidental VTE is an important contributor to rates of cancer-associated VTE and, in terms of outcomes, appears to be as consequential for patients as symptomatic VTE. Multiple biomarkers have been studied, with the highest level of evidence for prechemotherapy elevated platelet counts, elevated leukocyte counts, and low hemoglobin. Other candidate biomarkers, including D-dimer and tissue factor, are currently being evaluated. A recently validated risk score for chemotherapy-associated VTE has now been evaluated in more than 10 000 cancer patients in a variety of clinical settings and trials and is ready for clinical use (Level 1 clinical decision rule). Several randomized clinical trials in solid-tumor patients with low-molecular-weight heparins and semuloparin, an ultra-low-molecular-weight heparin, demonstrate clearly that outpatient thromboprophylaxis is feasible, safe, and effective. Selecting the appropriate patients for prophylaxis, however, continues to be a matter of controversy.

Measuring clinical practice: science and methods

2013 ◽  
Vol 34 (1) ◽  
pp. E3 ◽  
Author(s):  
Peter D. Angevine ◽  
Paul C. McCormick
Keyword(s):  
Clinical Trials ◽  
Clinical Data ◽  
Observational Studies ◽  
Randomized Clinical Trials ◽  
Treatment Options ◽  
Routine Practice ◽  
Clinical Settings ◽  
Clinical Registries ◽  
Basic Understanding

The routine practice of neurosurgery generates a large amount of clinical data. The structured, systematic capture of this information using clinical registries or other rigorously designed observational studies can yield useful evidence to help improve the care of patients. Registries in particular can be designed to measure outcomes in real-world clinical settings and to study differences in outcomes between subgroups. This information can help clinicians to advise patients regarding their treatment options. To provide valid, generalizable evidence, however, registries and other observational studies must be designed and conducted with a rigor similar to that of randomized clinical trials. Neurosurgeons with a basic understanding of the potential advantages and pitfalls of nonrandomized trials and the methods of statistical analysis will be able to assess the quality of clinical data and to incorporate the findings appropriately into their patients' care.

scholarly journals Dietary Interventions with Polyphenols in Osteoarthritis: A Systematic Review Directed from the Preclinical Data to Randomized Clinical Studies

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1420
Author(s):  
Evdokia Valsamidou ◽  
Aristea Gioxari ◽  
Charalampia Amerikanou ◽  
Panagiotis Zoumpoulakis ◽  
George Skarpas ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Synergistic Effects ◽  
Antioxidant Properties ◽  
Research Field ◽  
Clinical Settings ◽  
Dietary Interventions ◽  
Interesting Approach ◽  
Relationship Of

Osteoarthritis (OA) is the most common form of arthritis and a major cause of limited functionality and thus a decrease in the quality of life of the inflicted. Given the fact that the existing pharmacological treatments lack disease-modifying properties and their use entails significant side effects, nutraceuticals with bioactive compounds constitute an interesting field of research. Polyphenols are plant-derived molecules with established anti-inflammatory and antioxidant properties that have been extensively evaluated in clinical settings and preclinical models in OA. As more knowledge is gained in the research field, an interesting approach in the management of OA is the additive and/or synergistic effects that polyphenols may have in an optimized supplement. Therefore, the aim of this review was to summarize the recent literature regarding the use of combined polyphenols in the management of OA. For that purpose, a PubMed literature survey was conducted with a focus on some preclinical osteoarthritis models and randomized clinical trials on patients with osteoarthritis from 2018 to 2021 which have evaluated the effect of combinations of polyphenol-rich extracts and purified polyphenol constituents. Data indicate that combined polyphenols may be promising for the treatment of osteoarthritis in the future, but more clinical trials with novel approaches in the identification of the in-between relationship of such constituents are needed.

scholarly journals Acute Coronary Syndrome in Octogenerians: Management Perspectives

2020 ◽  
pp. 1-4
Author(s):  
Ranjan Modi ◽  
Sunil Modi ◽  
Ranjan Modi
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Medical Therapy ◽  
Randomized Clinical Trials ◽  
Coronary Syndrome ◽  
Younger Age ◽  
Current Guidelines ◽  
Term Data

Current guidelines for acute coronary syndrome are derived from the data in randomized clinical trials and metanalysis conducted in patients. These patients are generally of younger age. The data of acute coronary syndrome in octogenarians is mainly derived from registries. This mid and long-term data regarding medical therapy or interventions in octogenarians is low in number with smaller subsets of patients. Most of the physicians are reluctant to use the same guidelines in these elderly patients due to increased chances of complications. This article reviews the available data and literature in acute coronary syndrome in octogenarians and provides management perspectives for these elderly patients.

Randomized Clinical Trials in Surgery

1989 ◽  
Vol 5 (3) ◽  
pp. 317-332 ◽  
Author(s):  
Bucknam McPeek ◽  
Frederick Mosteller ◽  
Martin McKneally
Keyword(s):  
Clinical Trials ◽  
Sample Size ◽  
Comparative Effectiveness ◽  
Randomized Clinical Trials ◽  
Controlled Trial ◽  
Causal Link ◽  
Clinical Settings ◽  
Two Generations ◽  
The Relationship

When it is well conducted, a randomized clinical provides the strongest evidence available for evaluating the comparative effectiveness of the interventions tested. Over the last two generations, we have learned much about various devices for strengthening them and about methods of avoiding between in their design, execution, analysis, and reporting. In a trial, we seek evidence for a causal link between treatment and observed outcomes. Becaues the controlled trial depends on an argument based on exculsion (i.e., no other causes or differences affected the experimental groups), we strengthen its inference by taking steps to exclude any such differences.This article discusses a number of issues that deserve consideration: problems of multiplicity and generalizability, devices for strengthening trials, issues of power and sample size, the relationship between study design and reported gains, when to undertake a trial, the role of collaborative trials, and ways to make trials more feasible in clinical settings.

scholarly journals Anti-Inflammatory Drugs in Patients with Ischemic Heart Disease

2021 ◽  
Vol 10 (13) ◽  
pp. 2835
Author(s):  
Ana María Pello Lázaro ◽  
Luis M. Blanco-Colio ◽  
Juan Antonio Franco Peláez ◽  
José Tuñón
Keyword(s):  
Clinical Trials ◽  
Acetylsalicylic Acid ◽  
Cardiovascular Events ◽  
Randomized Clinical Trials ◽  
Renin Angiotensin System ◽  
Clinical Settings ◽  
Potential Candidate ◽  
Angiotensin System ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Inflammation has long been known to play a role in atherogenesis and plaque complication, as well as in some drugs used in therapy for atherosclerotic disease, such as statins, acetylsalicylic acid, and modulators of the renin-angiotensin system, which also have anti-inflammatory effects. Furthermore, inflammatory biomarkers have been demonstrated to predict the incidence of cardiovascular events. In spite of this, and with the exception of acetylsalicylic acid, non-steroidal anti-inflammatory drugs are unable to decrease the incidence of cardiovascular events and may even be harmful to the cardiovascular system. In recent years, other anti-inflammatory drugs, such as canakinumab and colchicine, have shown an ability to reduce the incidence of cardiovascular events in secondary prevention. Colchicine could be a potential candidate for use in clinical practice given its safety and low price, although the results of temporary studies require confirmation in large randomized clinical trials. In this paper, we discuss the evidence linking inflammation with atherosclerosis and review the results from various clinical trials performed with anti-inflammatory drugs. We also discuss the potential use of these drugs in routine clinical settings.

L-arginine effect on inflammatory mediators: A systematic review of randomized controlled clinical trials

2019 ◽  
pp. 1-9 ◽  
Author(s):  
Seyed Reza Mirhafez ◽  
Mitra Hariri
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Inflammatory Mediators ◽  
Randomized Clinical Trials ◽  
Randomized Controlled Clinical Trials ◽  
Patients With Cancer ◽  
Reactive Protein ◽  
Randomized Controlled ◽  
Human Adults ◽  
Factor Α

Abstract. L-arginine is an important factor in several physiological and biochemical processes. Recently, scientists studied L-arginine effect on inflammatory mediators such as C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). We conducted a systematic review on randomized controlled trials assessing L-arginine effect on inflammatory mediators. We searched data bases including Google scholar, ISI web of science, SCOPUS, and PubMed/Medline up to April 2019. Randomized clinical trials assessing the effect of L-arginine on inflammatory mediators in human adults were included. Our search retrieved eleven articles with 387 participants. Five articles were on patients with cancer and 6 articles were on adults without cancer. L-arginine was applied in enteral form in 5 articles and in oral form in 6 articles. Eight articles were on both genders, two articles were on women, and one article was on men. L-arginine could not reduce inflammatory mediators among patients with and without cancer except one article which indicated that taking L-arginine for 6 months decreased IL-6 among cardiopathic nondiabetic patients. Our results indicated that L-arginine might not be able to reduce selected inflammatory mediators, but for making a firm decision more studies are needed to be conducted with longer intervention duration, separately on male and female and with different doses of L-arginine.

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