scholarly journals Efficacy and safety of TiNO-coated stents versus drug-eluting coronary stents. Systematic literature review and meta-analysis

2020 ◽  
Author(s):  
Frederic C. Daoud ◽  
Louis Létinier ◽  
Nicholas Moore ◽  
Pierre Coste ◽  
Pasi P. Karjalainen
Keyword(s):  
Sensitivity Analysis ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Fixed Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
Drug Eluting

AbstractBackgroundRandomized clinical trials (RCTs) comparing percutaneous coronary interventions (PCI) with titanium-nitride-oxide coated stents (TiNOS) versus drug-eluting stents (DES) in coronary artery disease (CAD) have been published.ObjectivesTo compare the efficacy and safety of PCI with TiNOS versus DES at 1 and 5-year follow-up, in all CAD including acute coronary syndrome (ACS).MethodsA prospective systematic literature review and meta-analysis of RCTs were conducted according to published methods (Cochrane, PRISMA, GRADE). Medline, Embase, Cochrane database, Web of Science were searched on March 08, 2018. Fixed-effects Mantel-Haenszel pooled risk ratios (RR), TiNOS over DES, with 95% confidence intervals (CI) were computed with sensitivity analysis.ResultsFive RCTs were eligible with n = 1,855 TiNOS vs. n = 1,363 DES at 1-year and n = 783 vs. n = 771 at 5-year follow-up. One-year RRs in ACS patients: Major Adverse Cardiac Events (MACE) 0.93 [0.72, 1.20], recurrent myocardial infarction (MI) 0.42 [0.28, 0.63], probable or definite stent thrombosis (ST): 0.35 [0.20, 0.64]. Estimates were robust to sensitivity analysis. Certainty of evidence was high in MACE, moderate in MI and ST due to the limited number of cases. Data were insufficient to draw conclusions about stable CAD patients and 5-year outcomes.ConclusionsThis meta-analysis showed in ACS patients, similar risk of MACE with TiNOS and DES, at 1- year follow-up, and suggested a lower risk of MI and ST with TiNOS than with DES. These two safety signals in MI and ST with the current use of DES require further investigations.SLR registrationPROSPERO CRD42018090622 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90622

scholarly journals USE OF FLUNARIZINE AS A PREVENTIVE FOR VESTIBULAR MIGRAINE CRISES IN COMPARISON WITH OTHER DRUGS: SYSTEMATIC LITERATURE REVIEW

2021 ◽  
Author(s):  
Lara Estupina Braghieri ◽  
Paula Lopes ◽  
Osmar Person ◽  
Fernando Junior ◽  
Priscila Bogar
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Vestibular Migraine ◽  
Moderate Degree ◽  
Level Of Evidence ◽  
Grade Method ◽  
Episodic Vertigo ◽  
Preventive Drug

INTRODUCTION: Vestibular migraine is the main cause of episodic vertigo and the second most common cause of dizziness in adults. Treatment for vestibular migraine encompasses the prevention of crises and the control of acute symptoms. Flunarizine works by preventing the contraction of labyrinthine vessels and altering blood flow, thus preventing symptoms. Due to the high prevalence of the disease, its negative impacts on individual health and increased expenditure on public health, preventive pharmacological and non-pharmacological treatment must be implemented early. PURPOSE: To evaluate the efficacy of Flunarizine as a preventive for migraine and vestibular crises compared to other preventive drugs. MATERIAL AND METHODS: Scientific articles were searched in the databases using the terms (vestibular migraine OR migrainous vertigo) AND (flunarizine) AND (prophylaxis). Subsequently, a systematic literature review and meta-analysis was performed, including 3 randomized clinical trials comparing flunarizine and other preventive drugs in terms of efficacy and safety for preventing migraine vertigo attacks. The studies were analyzed using a ROB table, analysis using the GRADE method and meta-analysis. RESULTS: Qualitatively, the analysis showed that flunariniza was positive for decreasing the frequency of vertigo in cases of vestibular migraine, with a moderate degree of evidence, a relative risk of 0.34 and a confidence interval of 0.15 to 0.76. CONCLUSIONS: There are few studies available in the scientific literature on the use of flunarizine in vestibular migraine, many of which are heterogeneous among themselves, mainly in the way of evaluating and monitoring patients, carried out mainly through subjective methods. The meta-analysis showed a positive result for flunarizine as a preventive drug for the studied population. Furthermore, in all the studies analyzed, no serious side effects resulting from the use of the medication were reported, which makes it safe for patients to use. Flunarizine is a good drug for the prevention of vestibular migraine, especially in reducing the number of attacks, with a good level of evidence.

Efficacy and safety of drug-eluting balloon-only strategy (DEB-only) for de novo coronary artery disease: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W.Y Zhang ◽  
M.D Zhang ◽  
J.F Tian ◽  
M Zhang ◽  
Y Zhou ◽  
...  
Keyword(s):  
De Novo ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Late Lumen Loss ◽  
Drug Eluting ◽  
Coronary Lesions ◽  
Artery Disease ◽  
Drug Eluting Balloon

Abstract Background Many clinical trials have demonstrated the value of drug-eluting balloon (DEB) for in-stent restenosis. Recently, DEB for de novo lesions has also attracted more attention. There have been promising results of PCI using DEB alone in selected de novo coronary diseases (small vessels, bifurcating lesions, acute myocardial infarction). However, the application of DEB for patients with de novo coronary artery disease remains controversial due to relatively limited evidence. Purpose The purpose of this study was to evaluate the efficacy and safety DEB-only strategy (bail-out stents were allowed when required) compared with other modalities for the treatment of de novo coronary lesions. Methods We searched PubMed, Embase, Web of Science and Cochrane Library Central Register of Controlled Trials (CENTRAL) electronic databases for randomized controlled trials as well as observational studies published up to Jan 22, 2020. Studies which compared DEB-only approach with other PCI strategies for treatment of any type of de novo coronary lesions were identified. The primary outcome was late lumen loss (LLL) during angiographic follow up. The secondary outcomes were major adverse cardiac events (MACE), target lesion revascularisation (TLR) and binary in-segment restenosis. Results Nineteen studies (eleven randomised controlled trials and eight observational studies) with a total of 3,356 patients were included in this meta-analysis. Angiographic observations were obtained at 6 or 9 months and clinical follow-up duration ranged from 6 months to 36 months. Among the overall studies, the results indicated that DEB-only strategy was superior to the control groups for LLL (mean difference (MD) = −0.30mm; 95% confidence interval (CI), −0.41 to −0.19; P<0.001). DEBs were associated with a similar risk of MACE (risk ratio (RR): 0.84, 95% CI: 0.64, 1.11, P=0.22), TLR (RR: 0.79, 95% CI: 0.53, 1.16, P=0.23) and binary restenosis (RR: 0.68, 95% CI: 0.35, 1.31, P=0.25) compared with the control groups. In subgroup analysis, DEB-only strategy showed significantly better outcomes for most endpoints compared to POBA. Compared with DES, there were also significant favorable effects associated with treatment of DEB-only on LLL (MD: −0.14, 95% CI: −0.23, −0.04, P=0.005), while insignificant inter-strategy differences were observed in other endpoints. Vessel diameter did not have a significant influence on the result. Conclusion DEB-only intervention is an effective treatment associated with a significant reduction in late loss late lumen loss compared to other options. The efficacy and safety of DEB alone are comparable to those of DES and superior to POBA for treatment of selected de novo coronary lesions. Additional evidence is still warranted to confirm value of DEB before a widespread clinical utilization can be recommended. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Beijing Lab for Cardiovascular Precision Medicine

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