Protective Effects of Steroids in Cardiac Surgery: A Meta-Analysis of Randomized Double-Blind Trials

SummaryThe effect of desmopressin (DDAVP) on reducing postoperative blood loss after cardiac surgery has been studied in several randomized clinical trials, with conflicting outcomes. Since most trials had insufficient statistical power to detect true differences in blood loss, we performed a meta-analysis of data from relevant studies. Seventeen randomized, double-blind, placebo-controlled trials were analyzed, which included 1171 patients undergoing cardiac surgery for various indications; 579 of them were treated with desmopressin and 592 with placebo. Efficacy parameters were blood loss volumes and transfusion requirements. Desmopressin significantly reduced postoperative blood loss by 9%, but had no statistically significant effect on transfusion requirements. A subanalysis revealed that desmopressin had no protective effects in trials in which the mean blood loss in placebo-treated patients fell in the lower and middle thirds of distribution of blood losses (687-1108 ml/24 h). In contrast, in trials in which the mean blood loss in placebo-treated patients fell in the upper third of distribution (>1109 ml/24 h), desmopressin significantly decreased postoperative blood loss by 34%. Insufficient data were available to perform a sub-analysis on transfusion requirements. Therefore, desmopressin significantly reduces blood loss only in cardiac operations which induce excessive blood loss. Further studies are called to validate the results of this meta-analysis and to identify predictors of excessive blood loss after cardiac surgery.

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Clinical Efficacy of Phytodolor under special consideration of double-blind trials and their meta-analysis

Planta Medica ◽

10.1055/s-2007-986749 ◽

2007 ◽

Vol 73 (09) ◽

Cited By ~ 1

Author(s):

KJ Gundermann

Keyword(s):

Clinical Efficacy ◽

Meta Analysis ◽

Special Consideration ◽

Double Blind ◽

Blind Trials

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Comprehensive Comparisons among Inotropic Agents on Mortality and Risk of Renal Dysfunction in Patients Who Underwent Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm10051032 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1032

Author(s):

Wei-Cheng Chen ◽

Meng-Hsuan Lin ◽

Chieh-Lung Chen ◽

Ying-Chieh Chen ◽

Chih-Yu Chen ◽

...

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Renal Dysfunction ◽

Systolic Function ◽

Meta Analysis ◽

Treatment Strategies ◽

Controlled Trials ◽

Protective Effects ◽

Renal Protection ◽

Randomized Controlled

Several kinds of inotropes have been used in critically ill patients to improve hemodynamics and renal dysfunction after cardiac surgery; however, the treatment strategies for reducing mortality and increasing renal protection in patients who underwent cardiac surgery remain controversial. Therefore, we performed a comprehensive network meta-analysis to overcome the lack of head-to-head comparisons. A systematic database was searched up to 31 December 2020, for randomized controlled trials that compared different inotropes on mortality outcomes and renal protective effects after cardiac surgery. A total of 29 trials were included and a frequentist network meta-analysis was performed. Inconsistency analyses, publication bias, and subgroup analyses were also conducted. Compared with placebo, use of levosimendan significantly decreased the risks of mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56–0.97) and risk of acute renal injury (OR: 0.61; 95% CI: 0.45–0.82), especially in low systolic function patients. Use of levosimendan also ranked the best treatment based on the P-score (90.1%), followed by placebo (64.5%), milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam (17.0%). Taking all the available data into consideration, levosimendan was a safe renal-protective choice for the treatment of patients undergoing cardiac surgery, especially for those with low systolic function.

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QUESTION FOR META-ANALYSTS: CAN YOU MAKE A SILKEN PURSE OUT OF A SOW'S EAR?

PEDIATRICS ◽

10.1542/peds.84.4.a108 ◽

1989 ◽

Vol 84 (4) ◽

pp. A108-A108

Author(s):

Student

Keyword(s):

Rheumatoid Arthritis ◽

Meta Analysis ◽

Multiple Comparisons ◽

Measurement Scales ◽

Double Blind ◽

New Drug ◽

Baseline Difference ◽

Blind Trials

Choice of dose [in 196 double-blind trials of treatments for rheumatoid arthritis], multiple comparisons, wrong calculation, sub-group and within-group analyses, wrong sampling units. . . , change in measurement scales before analyses, baseline difference, and selecting reporting of significant results were some of the verified or possible causes for the large proportion of results that favored the [newly proposed] drug. Doubtful or invalid statements were found in 76% of the conclusions or abstracts. Bias consistently favored the new drug in 81 trials, and the control in only one trial. It is not obvious how a reliable meta-analysis could be done [reliably] in these trials.

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