P2838The impact of anesthesia depth on catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K H Li ◽  
T Sang ◽  
C P Chan ◽  
M Gong ◽  
G Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Catheter Ablation ◽  
Observational Studies ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Moderate Sedation ◽  
Complication Risk ◽  
Significant Difference ◽  
Procedural Success ◽  
Procedural Outcomes

Abstract Objectives This meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of catheter ablation in patients under GA/deep sedation and mild/moderate sedation. Background Catheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to general anesthesia. Methods PubMed and Embase were searched up to July 2018 for randomized controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. 12 studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger's regression, respectively. Results Our meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI: 0.56 to 1.13, P=0.20) and complications (RR: 0.95, 95% CI: 0.64 to 1.42, P=0.82), though statistically insignificant. In terms of procedural parameters, there was non-significant difference between the two groups when both procedural time (SMD: −0.13, 95% CI: −0.90 to 0.63, P=0.74) and fluoroscopy time (SMD: −0.41, 95% CI: −1.40 to 0.58, P=0.41) were considered. Multivariate meta-regression demonstrated hypertension as an independent moderating factor for complication risk. Complications Comparison Conclusion Apart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.

scholarly journals Anaesthesia use in catheter ablation for atrial fibrillation: a systematic review and meta-analysis of observational studies

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011155
Author(s):  
Ka Hou Christien Li ◽  
Tian Sang ◽  
Cheng Chan ◽  
Mengqi Gong ◽  
Yingzhi Liu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Observational Studies ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Recurrence Risk ◽  
Moderate Sedation ◽  
Significant Difference ◽  
Randomised Controlled

ObjectivesThis meta-analysis and systematic review seeks to compare both characteristic parameters and procedural outcomes of atrial fibrillation (AF) catheter ablation in patients under general anaesthesia (GA)/deep sedation and mild/moderate sedation.BackgroundCatheter ablation has become a widely applied intervention for treating symptomatic AF and arrhythmias that are refractory to medical therapy. It can be conducted through from mild sedation to GA.MethodsPubMed and Embase were searched up to July 2018 for randomised controlled trials, cohort and observational studies that assessed the outcomes of catheter ablation under GA/deep sedation or mild/moderate sedation. Nine studies were included in this meta-analysis after screening with the inclusion and exclusion criteria. Heterogeneity between studies and publication bias was evaluated by I2 index and Egger’s regression, respectively.ResultsOur meta-analysis found catheter AF ablation with GA/deep sedation to be associated with reduced risk of recurrence (RR: 0.79, 95% CI 0.56 to 1.13, p=0.20) and complications (RR: 0.95, 95% CI 0.64 to 1.42, p=0.82), though statistically insignificant. In terms of procedural parameters, there was no significant difference between the two groups for both procedural time (SMD: −0.13, 95% CI −0.90 to 0.63, p=0.74) and fluoroscopy time (SMD: −0.41, 95% CI −1.40 to 0.58, p=0.41). Univariate meta-regression did not reveal any covariates as a moderating factor for complication and recurrence risk.ConclusionApart from an increased likelihood of procedural success, ablation by GA/deep sedation was found to be non-significantly different from the mild/moderate sedation approach in both procedural parameters and outcome measures.

scholarly journals The association of fracture risk in atrial fibrillation patients and long-term anticoagulant therapy category: a systematic review and meta-analysis

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e10683
Author(s):  
Jun Chen ◽  
Lingchun Lyu ◽  
Jiayi Shen ◽  
Chunlai Zeng ◽  
Cheng Chen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Hip Fracture ◽  
Fracture Risk ◽  
Hip Fractures ◽  
Observational Studies ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hip Fracture Risk ◽  
Significant Difference

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

scholarly journals Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: a systematic review and meta-analysis

Perfusion ◽  
2020 ◽  
pp. 026765912095298
Author(s):  
Ariane Willems ◽  
Peter P Roeleveld ◽  
Sonia Labarinas ◽  
John W Cyrus ◽  
Jennifer A Muszynski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Observational Studies ◽  
Meta Analysis ◽  
Lower Mortality ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Significant Difference

The purpose was to compare time-based vs anti-Xa-based anticoagulation strategies in patients on ECMO. We conducted a systematic review and meta-analysis using multiple electronic databases and included studies from inception to July 19, 2019. The proportion of bleeding, thrombosis, and mortality were evaluated. Twenty-six studies (2,086 patients) were included. Bleeding occurred in 34.2% (95%CI 25.1;43.9) of the patients with anti-Xa-based versus 41.6% (95%CI 24.9;59.4) of the patients with time-based anticoagulation strategies. Thrombosis occurred in 32.6% (95%CI 19.1;47.7) of the patients with anti-Xa-based versus 38.4% (95%CI 22.2;56.1) of the patients with time-based anticoagulation strategies. And mortality rate was 35.4% (95%CI 28.9;42.1) of the patients with anti-Xa-based versus 42.9% (95%CI 36.9;48.9) of the patients with time-based anticoagulation strategies. Among the seven studies providing results from both anticoagulation strategies, significantly fewer bleeding events occurred in the anti-Xa-based anticoagulation strategy (adjusted OR 0.49 (95%CI 0.32;0.74), p < 0.001) and a significantly lower mortality rate (adjusted OR 0.61 (95%CI 0.40;0.95), p = 0.03). There was no significant difference in thrombotic events (adjusted OR 0.91 (95%CI 0.56;1.49), p = 0.71). In these seven observational studies, only a small fraction of the patients were adults, and data were insufficient to analyze the effect of the type of ECMO. In this meta-analysis of observational studies of patients on ECMO, an anti-Xa-based anticoagulation strategy, when compared to a time-based strategy, was associated with fewer bleeding events and mortality rate, without an increase in thrombotic events.

scholarly journals Renin Angiotensin System Inhibition and Susceptibility and Outcomes from COVID-19: A Systematic Review and Meta-analysis of 69,200 COVID-19 Patients

2020 ◽  
Author(s):  
Yi Zhang ◽  
Shikai Yu ◽  
Yawei Xu ◽  
Bryan Williams
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Meta Analysis ◽  
Renin Angiotensin System ◽  
Risk Of Infection ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Significant Difference ◽  
The Impact ◽  
Ras Inhibitors

ABSTRACTBackgroundEarly observational studies suggested that the use of the renin angiotensin system (RAS) inhibitors, specifically angiotensin converting enzyme inhibitors or angiotensin receptor blockers, may increase the risk of infection with SARS-CoV-2 and adversely affect the prognosis or survival of infected patients. To explore the impact of RAS inhibitor use on the risk of SARS-CoV-2 infection and the prognosis of SARS-CoV-2 infected patients, from all published studies.Methods and FindingsA systematic review and meta-analysis of the use of RAS inhibitors in relation to infection with SARS-CoV-2 and/or the severity and mortality associated with COVID-19 was conducted. English language bibliographic databases PubMed, Web of Science, OVID Embase, Scopus, MedRxiv, BioRxiv, searched from Jan 1st, 2020 to July 20th, 2020. 58 observational studies (69,200 COVID-19 patients and 3,103,335 controls) were included. There was no difference in the susceptibility to SARS-CoV-2 infection between RAS inhibitor users and non-users (unadjusted OR 1.05, 95% CI 0.90 to 1.21), (adjusted OR 0.93, 95% CI 0.85 to 1.02), (adjusted HR 1.07, 95% CI 0.87 to 1.31). There was no significant difference in the severe Covid-19 case rate between RAS inhibitor users and non-users (unadjusted OR 1.05, 95% CI 0.81 to 1.36), (adjusted OR 0.76, 95% CI 0.52 to 1.12), or in mortality due to COVID-19 between RAS inhibitor users and non-users (unadjusted OR 1.12, 95% CI 0.88 to 1.44), (adjusted OR 0.97, 95% CI 0.77 to 1.23), (adjusted HR 0.62, 95% CI 0.34 to 1.14).ConclusionsIn the most comprehensive analysis of all available data to date, treatment with RAS inhibitors was not associated with increased risk of infection, severity of disease, or mortality due to COVID-19. The best available evidence suggests that these treatments should not be discontinued on the basis of concern about risk associated with COVID-19.

scholarly journals Bone Mineral Density, Osteoporosis, and Fracture Risk in Adult Patients with Psoriasis or Psoriatic Arthritis: A Systematic Review and Meta-Analysis of Observational Studies

2020 ◽  
Vol 9 (11) ◽  
pp. 3712
Author(s):  
Tai-Li Chen ◽  
Jing-Wun Lu ◽  
Yu-Wen Huang ◽  
Jen-Hung Wang ◽  
Kuei-Ying Su
Keyword(s):  
Bone Mineral Density ◽  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Bone Mineral ◽  
Observational Studies ◽  
Meta Analysis ◽  
Mineral Density ◽  
Psoriatic Disease ◽  
Increased Risk ◽  
Significant Difference

Introduction: Awareness of psoriasis-related comorbidities has been established in the current guidelines; however, evidence regarding the association of bone density or bone fragility with psoriatic disease remains inconclusive. Methods: We conducted a systematic review and meta-analysis to assess bone mineral density and the risk of osteoporosis and fractures in patients with psoriatic disease, including those with cutaneous psoriasis and psoriatic arthritis. We searched electronic databases for published observational studies. A meta-analysis was performed using the random-effect model. Pooled estimates and their confidence intervals (CIs) were calculated. Small-study effects were examined using the Doi plot and Luis Furuya–Kanamori index. Results: The analysis of the standardized mean difference in the absolute value of bone mineral density at different measuring sites (lumbar spine, femoral neck, and total hip) revealed no significant difference between patients with psoriatic disease and non-psoriatic controls. The pooled results of the adjusted odds ratios (ORs) demonstrated no increased risk of osteoporosis in patients with psoriatic disease. Notably, patients with psoriatic disease had a higher OR of developing bone fractures (adjusted OR: 1.09; 95% CI: 1.06 to 1.12; I2: 0%). Conclusion: Patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls. This higher risk for fracture may not necessarily be associated with lower bone mineral density nor a higher risk for osteoporosis.

scholarly journals Non-pharmacological interventions to improve the patient experience of colonoscopy under moderate or no sedation: a systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038621
Author(s):  
Colin Sue-Chue-Lam ◽  
Matthew Castelo ◽  
Jill Tinmouth ◽  
Diego Llovet ◽  
Teruko Kishibe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Experience ◽  
Deep Sedation ◽  
Meta Analysis ◽  
Critical Dimension ◽  
Study Data ◽  
Pharmacological Interventions ◽  
Screening Process ◽  
Moderate Sedation ◽  
Randomised Controlled

IntroductionThe patient experience is a critical dimension of colonoscopy quality. Sedative and analgesic drugs are commonly used to improve the patient experience of colonoscopy, with predominant regimens being deep sedation, typically achieved with propofol, and moderate sedation, typically achieved with an opioid and a benzodiazepine. However, non-pharmacological interventions exist that may be used to improve patient experience. Furthermore, by identifying non-pharmacological interventions to increase the quality of patient experience under moderate sedation, jurisdictions facing rising use of deep sedation for colonoscopy and its significant associated costs may be better able to encourage patients and clinicians to adopt moderate sedation. Advancing either of these aims requires synthesising the evidence and raising awareness around these non-pharmacological interventions to improve the patient experience of colonoscopy.Methods and analysisA systematic review will be conducted that searches multiple electronic databases from inception until 2020 to identify randomised controlled trials evaluating what, if any, non-pharmacological interventions are effective compared with placebo or usual care for improving the patient experience of routine colonoscopy under moderate or no sedation. Two reviewers will independently perform a three-stage screening process and extract all study data using piloted forms. Study quality will be assessed using the Cochrane Risk of Bias Tool V.2.0. Where multiple studies evaluate a single intervention, evidence will be quantitatively synthesised using pairwise meta-analysis, otherwise narrative syntheses will be undertaken.Ethics and disseminationThis is a review of existing literature not requiring ethics approval. The review findings will be included in future efforts to develop an implementation strategy to reduce the use of deep sedation for routine colonoscopy. They will also be published in a peer-reviewed journal, presented at conferences and contribute to a doctoral thesis.PROSPERO registration numberCRD42020173906.

scholarly journals Does Adjuvant Steroid Therapy Post-Kasai Portoenterostomy Improve the Outcome of Biliary Atresia? A Systematic Review and Meta-Analysis

2011 ◽  
Vol 25 (8) ◽  
pp. 440-444 ◽  
Author(s):  
Ahmed Sarkhy ◽  
Richard A Schreiber ◽  
Ruth Milner ◽  
Collin C Barker
Keyword(s):  
Systematic Review ◽  
Liver Transplantation ◽  
Biliary Atresia ◽  
Steroid Therapy ◽  
Observational Studies ◽  
Serum Bilirubin ◽  
Meta Analysis ◽  
Kasai Portoenterostomy ◽  
Significant Difference

BACKGROUND: The role of adjuvant steroid therapy in the postoperative management of patients with biliary atresia (BA) is unclear.OBJECTIVE: To systematically review the literature and perform a meta-analysis to determine the efficacy of adjuvant steroid therapy post-Kasai portoenterostomy (KP) on BA outcome.METHODS: A systematic review and meta-analysis of randomized trials and/or observational studies that examined the role of steroids on BA outcomes published between January 1969 and June 2010 was conducted. Studies were identified using the Medline, PubMed, EMBASE and Cochrane databases.RESULTS: Sixteen observational studies and one randomized controlled trial (RCT) were found. Four of the 16 observational studies (160 participants) and the RCT (73 participants) met the entry criteria and were eligible to be included in the analysis. There was no statistically significant difference in the effect of steroids either on normalizing serum bilirubin levels at six months (pooled OR 1.48 [95% CI 0.67 to 3.28]) or in delaying the need for early liver transplantation (within the first year post-KP (pooled OR 0.59 [95% CI 0.21 to 1.72]).CONCLUSION: The present meta-analysis did not find a significant effect of steroid over standard therapy, either in normalizing serum bilirubin levels at six months or at delaying the need for early liver transplantation post-KP. RCT studies of sufficient size and comprehensive design using high-dose steroids are needed to determine the effectiveness of steroids on the short and intermediate post-KP outcomes for BA patients.

Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Jean Maxime Côté ◽  
Louis Pinard ◽  
Jean-Francois Cailhier ◽  
Renée Lévesque ◽  
Patrick T. Murray ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Observational Studies ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Cochrane Library ◽  
Significant Difference ◽  
Short Term Mortality ◽  
Circuit Loss

<b><i>Introduction:</i></b> In critically ill patients requiring intermittent renal replacement therapy (RRT), the benefits of convective versus diffusive clearance remain uncertain. We conducted a systematic review and meta-analysis to determine the safety, clinical efficacy, and clearance efficiency of hemofiltration (HF) and hemodiafiltration (HDF) compared to hemodialysis (HD) in patients with acute kidney injury (AKI) receiving intermittent RRT. <b><i>Method:</i></b> We searched Medline, Embase, Cochrane Library, and PROSPERO. We included clinical trials and observational studies that reported the use of intermittent HF or HDF in adult patients with AKI. The following outcomes were included: mortality, renal recovery, clearance efficacy, intradialytic hemodynamic stability, circuit loss, and inflammation modulation. <b><i>Results:</i></b> A total of 3,169 studies were retrieved and screened. Four randomized controlled trials and 4 observational studies were included (<i>n</i>: 615 patients). Compared with conventional HD, intermittent convective therapies had no effect on in-hospital mortality (relative risk, 1.23; 95% confidence interval (CI), 0.76–1.99), renal recovery at 30 days (RR, 0.98; 95% CI, 0.82–1.16), time-to-renal recovery (mean difference [MD], 0.77; 95% CI, −6.56 to 8.10), and number of dialysis sessions until renal recovery (MD, −1.34; 95% CI, −3.39 to 0.72). The overall quality of included studies was low, and dialysis parameters were suboptimal for all included studies. <b><i>Conclusion:</i></b> This meta-analysis suggests that there is no significant difference in short-term mortality and renal recovery in patients with severe AKI when treated with intermittent HF or HDF compared to conventional HD. This systematic review emphasizes the need for further trials evaluating optimal convective parameters in AKI patients treated with intermittent dialysis.

Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in Treatment of Knee Osteoarthritis (Systematic Review and Meta-analysis)

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Atef Mohamed El-beltagy ◽  
Zeiad M Zakaria ◽  
; Mohamed Abdel-Samei Ibrahim
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Observational Studies ◽  
Platelet Rich Plasma ◽  
Meta Analysis ◽  
Knee Oa ◽  
Vas Score ◽  
Significant Difference ◽  
Meta Analyses

Abstract Background Although PRP is one of the options in the management of knee OA, its effectiveness and wide application is still controversial. Therefore, we conducted the present systematic review and meta-analysis to compare the safety and effectiveness of PRP versus HA injection for knee OA. Objective The purpose of this study is to compare between the efficacy of intra-articular injections of Platelet-Rich Plasma versus Hyaluronic Acid in treatment of knee osteoarthritis. Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The overall effect favoured PRP over HA for WOMAC function score, WOMAC pain score, WOMAC stiffness score, and WOMAC total score; mostly 6 and 12 months after treatment. According VAS score, we found that the overall effect favoured PRP over HA at 12 months only. In contrary, the overall effect did not favour PRP over HA for VAS score at 3 and 6 months. PRP is superior to HA for IKDC scores at 6 and 12 months with similar results at 3 months. Conclusion Intra-articular PRP injection is more effective in terms of pain relief and function improvement at short-term follow-up in the treatment of knee OA than HA, and there is no significant difference in the risk of adverse events between PRP and HA. A randomized controlled trial with larger group sizes is necessary to find the predictors of the response to PRP and HA intra-articular injection.

Sign in / Sign up

Export Citation Format

Share Document