Fibrinogen Supplementation and Its Indications

2019 ◽  
Vol 46 (01) ◽  
pp. 038-049 ◽  
Author(s):  
Oliver Grottke ◽  
Shuba Mallaiah ◽  
Keyvan Karkouti ◽  
Fuat Saner ◽  
Thorsten Haas
Keyword(s):  
Randomized Controlled Trials ◽  
Point Of Care ◽  
Treatment Options ◽  
Coagulation Factor ◽  
Coagulation Factors ◽  
Controlled Trials ◽  
Severe Bleeding ◽  
Fibrinogen Concentrate ◽  
Minimum Concentration ◽  
Randomized Controlled

AbstractAdequate plasma levels of fibrinogen are essential for clot formation, and in severe bleeding, fibrinogen reaches a critically low plasma concentration earlier than other coagulation factors. Although the critical minimum concentration of fibrinogen to maintain hemostasis is a matter of debate, many patients with coagulopathic bleeding require fibrinogen supplementation. Among the treatment options for fibrinogen supplementation, fibrinogen concentrate may be viewed by some as preferable to fresh frozen plasma or cryoprecipitate. The authors review major studies that have assessed fibrinogen treatment in trauma, cardiac surgery, end-stage liver disease, postpartum hemorrhage, and pediatric patients. Some but not all randomized controlled trials have shown that fibrinogen concentrate can be beneficial in these settings. The use of fibrinogen as part of coagulation factor concentrate based therapy guided by point-of-care viscoelastic coagulation monitoring (ROTEM [rotational thromboelastometry] or TEG [thromboelastography]) appears promising. In addition to reducing patients' exposure to allogeneic blood products, this strategy may reduce the risk of complications such as transfusion-associated circulatory overload, transfusion-related acute lung injury, and thromboembolic adverse events. Randomized controlled trials are challenging to perform in patients with critical bleeding, and more evidence is needed in this setting. However, current scientific rationale and clinical data support fibrinogen repletion in patients with ongoing bleeding and confirmed fibrinogen deficiency.

scholarly journals Coccydynia—The Efficacy of Available Treatment Options: A Systematic Review

2021 ◽  
pp. 219256822110653
Author(s):  
Gustav Ø. Andersen ◽  
Stefan Milosevic ◽  
Mads M. Jensen ◽  
Mikkel Ø. Andersen ◽  
Ane Simony ◽  
...  
Keyword(s):  
Systematic Review ◽  
Experimental Study ◽  
Treatment Outcome ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Treatment Options ◽  
Controlled Trials ◽  
Single Measure ◽  
Randomized Controlled ◽  
Radiofrequency Therapy

Study design Systematic Review Objective To evaluate the efficacy of available treatment options for patients with persistent coccydynia through a systematic review. Methods Original peer-reviewed publications on treatment for coccydynia were identified using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines by performing a literature search of relevant databases, from their inception to January 17, 2020, combined with other sources. Data on extracted treatment outcome was pooled based on treatment categories to allow for meta-analysis. All outcomes relevant to the treatment efficacy of coccydynia were extracted. No single measure of outcome was consistently present among the included studies. Numeric Rating Scale, (NRS, 0–10) for pain was used as the primary outcome measure. Studies with treatment outcome on adult patients with chronic primary coccydynia were considered eligible. Results A total of 1980 patients across 64 studies were identified: five randomized controlled trials, one experimental study, one quasi-experimental study, 11 prospective observational studies, 45 retrospective studies and unpublished data from the DaneSpine registry. The greatest improvement in pain was achieved by patients who underwent radiofrequency therapy (RFT, mean Visual Analog Scale (VAS) decreased by 5.11 cm). A similar mean improvement was achieved from Extracorporeal Shockwave Therapy (ESWT, 5.06), Coccygectomy (4.86) and Injection (4.22). Although improved, the mean change was less for those who received Ganglion block (2.98), Stretching/Manipulation (2.19) and Conservative/Usual Care (1.69). Conclusion This study highlights the progressive nature of treatment for coccydynia, starting with noninvasive methods before considering coccygectomy. Non-surgical management provides pain relief for many patients. Coccygectomy is by far the most thoroughly investigated treatment option and may be beneficial for refractory cases. Future randomized controlled trials should be conducted with an aim to compare the efficacy of interventional therapies amongst each other and to coccygectomy.

“Efficacy and Safety of Fibrinogen Concentrate in Surgical Patients: A Meta-analysis of Randomized Controlled Trials”

2017 ◽  
Vol 31 (2) ◽  
pp. e33-e35 ◽  
Author(s):  
Carlo Mengoli ◽  
Massimo Franchini ◽  
Giancarlo Maria Marano ◽  
Stefania Vaglio ◽  
Simonetta Pupella ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Fibrinogen Concentrate ◽  
Randomized Controlled

scholarly journals Overview of Pharmacological Treatment Options for Pediatric Patients with Refractory Kawasaki Disease

2015 ◽  
Vol 20 (3) ◽  
pp. 163-177
Author(s):  
Seyyedeh Saneeymehri ◽  
Katherine Baker ◽  
Tsz-Yin So
Keyword(s):  
Kawasaki Disease ◽  
Randomized Controlled Trials ◽  
Case Reports ◽  
Treatment Options ◽  
Infectious Agent ◽  
Initial Therapy ◽  
Cytotoxic Agents ◽  
Controlled Trials ◽  
Clinical Expertise ◽  
Randomized Controlled

Kawasaki disease is an autoimmune disease found predominantly in children under the age of 5 years. Its incidence is higher in those who live in Asian countries or are of Asian descent. Kawasaki disease is characterized as an acute inflammation of the vasculature bed affecting mainly the skin, eyes, lymph nodes, and mucosal layers. Although the disease is usually self-limiting, patients may develop cardiac abnormalities that can lead to death. The exact cause of the disease is unknown; however, researchers hypothesize that an infectious agent is responsible for causing Kawasaki disease. Initial treatment options with intravenous immune globulin and aspirin are sufficient to cure most patients who acquire this disease. Unfortunately, in up to one-quarter of patients, the disease will be refractory to initial therapy and will require further management with corticosteroid, immunomodulatory, or cytotoxic agents. The lack of randomized, controlled trials makes treatment of refractory disease difficult to manage. Until larger randomized, controlled trials are published to give more guidance on therapy for this stage of disease, clinicians should use the data available from observational studies and case reports in conjunction with their clinical expertise to make treatment decisions.

Clinical and Imaging Assessment, Staging and Decision Making in Laryngeal Cancers

2010 ◽  
Vol 2 (3) ◽  
pp. 175-183
Author(s):  
Rakesh Badhe
Keyword(s):  
Decision Making ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Treatment Options ◽  
Controlled Trials ◽  
Oncological Safety ◽  
Randomized Controlled

Abstract Cancer of the larynx has numerous implications—respiration, swallowing and speech, besides disability, vocational, recreational, etc. There are numerous treatment options which have been proven to be effective with randomized controlled trials and meta-analysis’. Often, the choice of modality offered to the patient is tailored to the patient's requirements as regard to his/her domestic, vocational and recreational environment. Although we may have a plethora of options for patients belonging to each stage of the disease, there are certain guidelines which must be adhered to in order to prevent any compromise of oncological safety. This article focuses on the planning of the treatment options based on various assessment modalities.

Treatment of metastatic castration sensitive prostate cancer (mCSPC) by disease volume: A systematic review and a meta-analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17539-e17539
Author(s):  
Qurat Ul Ain Riaz Sipra ◽  
Irbaz Bin Riaz ◽  
Noureen Asghar ◽  
Rabbia Siddiqi ◽  
Steven R Hwang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Randomized Controlled Trials ◽  
Treatment Options ◽  
Random Effect ◽  
Random Effect Model ◽  
Progression Free Survival ◽  
High Volume ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Initial Agent

e17539 Background: Chemotherapy with Docetaxel (D) or androgen pathway inhibition (API) with Abiraterone Acetate plus prednisone (AAP), Aplautamide(APA) and Enzalutamide(E) are acceptable, FDA approved treatment options for mCSPC. It is not clear whether the magnitude of benefit varies by the choice of initial agent [chemotherapy vs API] or by volume of disease [High vs Low]. Data is now available from all registration trials by volume status and motivated this analysis to inform initial treatment choice in mCSPC. Methods: We systematically searched MEDLINE(Ovid), Embase, and Scopus for randomized controlled trials of chemotherapy(D) or APIs (AAP, APA, ENZ) that had available hazard ratios (HRs) for overall survival (OS) and Progression Free Survival (PFS) according to patient’s volume of disease. We also reviewed abstracts and presentations from all major conference proceedings. We calculated the pooled overall survival HR and 95% CI by chemotherapy and APIs and by high volume(HVD) and low volume(LVD) using a random effect model, and tested for heterogeneity to assess the null hypothesis that no difference in the survival advantage exists by choice of initial agent and volume of disease. Results: Of 4456 studies identified in our search, there were 8 eligible randomized controlled trials that were included in the analysis. Both D and APIs significantly improved PFS [HR 0.48; 0.45-0.51] and OS [0.72; 0.64-0.81] when added to ADT, however the latter was associated with significantly higher improvement in PFS( P < 0.01) and OS (P = 0.03). In patients treated with D, patients with HVD derive significantly more benefit as compared to LVD( P = 0.046) and patients treated with APIs both HVD and LVD patients derive similar benefit( P = 0.80) (Table). Conclusions: mCSPC patients derive higher magnitude of survival benefit when treated with APIs as compared to D; however, D may be preferred in HVD patients. [Table: see text]

scholarly journals Lumbar spondylolisthesis: modern registries and the development of artificial intelligence

2019 ◽  
Vol 30 (6) ◽  
pp. 729-735 ◽  
Author(s):  
Zoher Ghogawala ◽  
Melissa R. Dunbar ◽  
Irfan Essa
Keyword(s):  
Artificial Intelligence ◽  
Randomized Controlled Trials ◽  
Predictive Analytics ◽  
Treatment Options ◽  
Degenerative Spondylolisthesis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Spine Care ◽  
Lumbar Spondylolisthesis

OBJECTIVEThere are a wide variety of comparative treatment options in neurosurgery that do not lend themselves to traditional randomized controlled trials. The object of this article was to examine how clinical registries might be used to generate new evidence to support a particular treatment option when comparable options exist. Lumbar spondylolisthesis is used as an example.METHODSThe authors reviewed the literature examining the comparative effectiveness of decompression alone versus decompression with fusion for lumbar stenosis with degenerative spondylolisthesis. Modern data acquisition for the creation of registries was also reviewed with an eye toward how artificial intelligence for the treatment of lumbar spondylolisthesis might be explored.RESULTSCurrent randomized controlled trials differ on the importance of adding fusion when performing decompression for lumbar spondylolisthesis. Standardized approaches to extracting data from the electronic medical record as well as the ability to capture radiographic imaging and incorporate patient-reported outcomes (PROs) will ultimately lead to the development of modern, structured, data-filled registries that will lay the foundation for machine learning.CONCLUSIONSThere is a growing realization that patient experience, satisfaction, and outcomes are essential to improving the overall quality of spine care. There is a need to use practical, validated PRO tools in the quest to optimize outcomes within spine care. Registries will be designed to contain robust clinical data in which predictive analytics can be generated to develop and guide data-driven personalized spine care.

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