Benefits and safety of transdermal glyceryl trinitrate in acute stroke: a systematic review and meta‐analysis of randomised trials

2021 ◽  
Author(s):  
Beng Leong Lim ◽  
Wei Feng Lee ◽  
Wei Ming Ng ◽  
Wangmin Situ ◽  
Kee Vooi Loo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Randomised Trials

scholarly journals Benefits and safety of transdermal glyceryl trinitrate in acute stroke: a systematic review and meta-analysis of randomised trials (protocol)

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043591
Author(s):  
Beng Leong Lim ◽  
Wei Feng Lee ◽  
Wei Ming Ng ◽  
Wei Ling Tay ◽  
Wui Ling Chan
Keyword(s):  
Systematic Review ◽  
Ischaemic Stroke ◽  
Glyceryl Trinitrate ◽  
Acute Stroke ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Cochrane Library ◽  
Placebo Control ◽  
Randomised Trials ◽  
Patient Subgroup

IntroductionHigh blood pressure (BP) in acute stroke has adverse outcomes. Transdermal glyceryl trinitrate (GTN) has beneficial properties in controlling BP. The 2016 meta-analysis and 2017 Cochrane review showed that transdermal GTN was beneficial in a small patient subgroup with stroke onset ≤6 hours. Larger studies focusing on this patient subgroup have since been conducted. We report the protocol for an updated systematic review and meta-analysis on the safety and benefits of transdermal GTN in acute stroke.Methods and analysisWe will search Medline, Pubmed, Embase, CINAHL and Cochrane Library from inception until June 2020 for randomised trials that report the efficacy and safety of transdermal GTN versus placebo/control therapy among adult patients with acute stroke. Primary outcomes include in-hospital mortality, BP lowering and late functional status. Secondary outcomes include early, late, resource utilisation and surrogate outcomes. Safety outcomes include reported adverse events. Reviewers will first screen titles and abstracts, and then full texts, to identify eligible studies. Independently and in duplicate, they will extract data, assess risk of bias (RoB) using a modified Cochrane RoB tool and quality of evidence using Grading of Recommendations, Assessment, Development and Evaluation. Disagreement will be resolved by discussion and consultation with an external reviewer if necessary. Using a random-effects model, we will report effect sizes using relative risks and 95% CIs. We will perform predefined subgroup analyses: intracerebral haemorrhage versus ischaemic stroke; minor (NIHSS (National Institutes of Health Stroke Scale) ≤five) versus major (NIHSS >five) ischaemic stroke; ischaemic stroke with versus without thrombolysis; prehospital versus non-prehospital settings; time from stroke to randomisation ≤6 versus >6 hours and high versus low overall RoB studies. We will also perform trial sequential analysis for the primary outcomes.Ethics and disseminationEthics board approval is unnecessary. PROSPERO registration has been obtained. The results will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020173093.

Timing of Oral P2Y12 Inhibitors in Non-ST-Elevation Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Randomised Trials

2021 ◽  
Vol 30 ◽  
pp. S247-S248
Author(s):  
L. Dawson ◽  
J. Bloom ◽  
J. Lefkovits ◽  
A. Taylor ◽  
S. Duffy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Randomised Trials ◽  
P2y12 Inhibitors ◽  
Coronary Syndromes ◽  
St Elevation

scholarly journals Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of randomised trials

2021 ◽  
Author(s):  
Naveed Sattar ◽  
Matthew M Y Lee ◽  
Søren L Kristensen ◽  
Kelley R H Branch ◽  
Stefano Del Prato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Randomised Trials ◽  
Receptor Agonists

Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis

2016 ◽  
Vol 37 (8) ◽  
pp. 1195-1202 ◽  
Author(s):  
Weibin Zhong ◽  
Na Geng ◽  
Pengfei Wang ◽  
Zhenguang Li ◽  
Lili Cao
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Acute Stroke ◽  
Transient Ischemic Attack ◽  
Meta Analysis ◽  
Hospital Readmissions ◽  
Ischemic Attack ◽  
Causes And Risk Factors

scholarly journals Interleukin-6, C-reactive protein, fibrinogen, and risk of recurrence after ischaemic stroke: Systematic review and meta-analysis

2021 ◽  
pp. 239698732098400
Author(s):  
JJ McCabe ◽  
E O’Reilly ◽  
S Coveney ◽  
R Collins ◽  
L Healy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Interleukin 6 ◽  
Inflammatory Markers ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Randomised Trials ◽  
C Reactive Protein ◽  
Vascular Events ◽  
Reactive Protein

Background Recent randomised trials showed benefit for anti-inflammatory therapies in coronary disease but excluded stroke. The prognostic value of blood inflammatory markers after stroke is uncertain and guidelines do not recommend their routine measurement for risk stratification. Methods We performed a systematic review and meta-analysis of studies investigating the association of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen and risk of recurrent stroke or major vascular events (MVEs). We searched EMBASE and Ovid Medline until 10/1/19. Random-effects meta-analysis was performed for studies reporting comparable effect measures. Results Of 2,515 reports identified, 39 met eligibility criteria (IL-6, n = 10; CRP, n = 33; fibrinogen, n = 16). An association with recurrent stroke was reported in 12/26 studies (CRP), 2/11 (fibrinogen) and 3/6 (IL-6). On random-effects meta-analysis of comparable studies, CRP was associated with an increased risk of recurrent stroke [pooled hazard ratio (HR) per 1 standard-deviation (SD) increase in loge-CRP (1.14, 95% CI 1.06–1.22, p < 0.01)] and MVEs (pooled HR 1.21, CI 1.10–1.34, p < 0.01). Fibrinogen was also associated with recurrent stroke (HR 1.26, CI 1.07–1.47, p < 0.01) and MVEs (HR 1.31, 95% CI 1.15–1.49, p < 0.01). Trends were identified for IL-6 for recurrent stroke (HR per 1-SD increase 1.17, CI 0.97–1.41, p = 0.10) and MVEs (HR 1.22, CI 0.96–1.55, p = 0.10). Conclusion Despite evidence suggesting an association between inflammatory markers and post-stroke vascular recurrence, substantial methodological heterogeneity was apparent between studies. Individual-patient pooled analysis and standardisation of methods are needed to determine the prognostic role of blood inflammatory markers and to improve patient selection for randomised trials of inflammatory therapies.

P–394 Intralipid infusion at time of embryo transfer in women with history of recurrent implantation failure: a systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M P Rimmer ◽  
N Black ◽  
S Keay ◽  
S Quenby ◽  
B. H.A Wattar
Keyword(s):  
Systematic Review ◽  
Embryo Transfer ◽  
Meta Analysis ◽  
Small Sample ◽  
Risk Of Bias ◽  
Population Characteristics ◽  
Implantation Failure ◽  
Randomised Trials ◽  
Recurrent Implantation Failure ◽  
History Of

Abstract Study question What is the effectiveness of IV Intralipid (IVI) in improving pregnancy rates in women undergoing IVF with history of Recurrent implantation failure (RIF) to improve reproductive outcomes. Summary answer The evidence to support the use of IVI at the time of embryo transfer in women with RIF is limited. More RCTs are needed. What is known already: Optimising the implantation process following embryo transfer remains a clinical challenge with 10% of couples undergoing IVF affected by (RIF). Immunotherapy could help to optimise endometrial receptivity and increase the chances for successful conception in women with history of RIF. Intra-venous Intralipid (IVI), a fat-based emulsion of soybean oil, glycerine, phospholipids, egg, and polyunsaturated fatty acids, has been evaluated in several trials as a potential intervention to downregulate the uNK cells and macrophages as well as inhibit the pro-inflammatory mediators including T1 helper cells. Evidence synthesis is needed to evaluate the effectiveness of this intervention. Study design, size, duration We performed this systematic review using a prospectively registered protocol (CRD42019148517) and reported in accordance with the PRISMA guidelines. Participants/materials, setting, methods: We searched MEDLINE, EMBASE and CENTRAL for any randomised trials evaluating the use of IVI at the time of embryo transfer in women undergoing assisted conception until September 2020. We extracted data in duplicate and assessed risk of bias using the Cochrane Risk of Bias tools. We meta-analysed data using a random effect model and reported on dichotomous outcomes using risk ratio (RR) and 95% confidence interval (CI). Main results and the role of chance We included five randomised trials reporting on 843 women with an overall moderate risk of bias. All trials used 20% IVI solution at the time of embryo transfer compared to normal saline infusion or no intervention (routine care). The IVI group had a higher chance of clinical pregnancy (172 vs 119, RR 1.55, 95%CI 1.16–2.07, I2 44.2%) and live birth (132 vs 73, RR 1.83, 95%CI 1.42–2.35, I2 0%) post treatment compared to no intervention. Limitations, reasons for caution Our findings are limited by the small sample size and the variations in treatment protocols and population characteristics. Wider implications of the findings: Our meta-analysis offers an overview on the value of IVI to help women affected by RIF. Given the limitations and the quality of included trials, adopting the use of IVI a-la-carte to couples undergoing IVF remains immature. IVI should not be offered until larger RCTs demonstrate a persistent benefit. Trial registration number CRD42019148517

scholarly journals Added value of combining methotrexate with a biological agent compared to biological monotherapy in rheumatoid arthritis patients: A systematic review and meta-analysis of randomised trials

2019 ◽  
Vol 48 (6) ◽  
pp. 958-966 ◽  
Author(s):  
Simon Tarp ◽  
Tanja S. Jørgensen ◽  
Daniel E. Furst ◽  
Anna Dossing ◽  
Peter C. Taylor ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Meta Analysis ◽  
Biological Agent ◽  
Added Value ◽  
Randomised Trials

Intravenous Insulin Treatment in Acute Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2013 ◽  
Vol 9 (4) ◽  
pp. 489-493 ◽  
Author(s):  
G. Ntaios ◽  
V. Papavasileiou ◽  
A. Bargiota ◽  
K. Makaritsis ◽  
P. Michel
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Acute Stroke ◽  
Insulin Treatment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Intravenous Insulin

scholarly journals Effects of cerebral near-infrared spectroscopy on the outcome of patients undergoing cardiac surgery: a systematic review of randomised trials

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016613 ◽  
Author(s):  
Giuseppe Filiberto Serraino ◽  
Gavin J Murphy
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Infrared Spectroscopy ◽  
Resource Use ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Meta Analysis ◽  
Red Cell ◽  
Randomised Trials ◽  
Red Cell Transfusion

ObjectivesGoal-directed optimisation of cerebral oxygenation using near-infrared spectroscopy (NIRS) during cardiopulmonary bypass is widely used. We tested the hypotheses that the use of NIRS cerebral oximetry results in reductions in cerebral injury (neurocognitive function, serum biomarkers), injury to other organs including the heart and brain, transfusion rates, mortality and resource use.DesignSystematic review and meta-analysis.SettingTertiary cardiac surgery centres in North America, Europe and Asia.ParticipantsA search of Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature Plus from inception to November 2016 identified 10 randomised trials, enrolling a total of 1466 patients, all in adult cardiac surgery.InterventionsNIRS-based algorithms designed to optimise cerebral oxygenation versus standard care (non-NIRS-based) protocols in cardiac surgery patients during cardiopulmonary bypass.Outcome measuresMortality, organ injury affecting the brain, heart and kidneys, red cell transfusion and resource use.ResultsTwo of the 10 trials identified in the literature search were considered at low risk of bias. Random-effects meta-analysis demonstrated similar mortality (risk ratio (RR) 0.76, 95% CI 0.30 to 1.96), major morbidity including stroke (RR 1. 08, 95% CI 0.40 to 2.91), red cell transfusion and resource use in NIRS-treated patients and controls, with little or no heterogeneity. Grades of Recommendation, Assessment, Development and Evaluation of the quality of the evidence was low or very low for all of the outcomes assessed.ConclusionsThe results of this systematic review did not support the hypotheses that cerebral NIRS-based algorithms have clinical benefits in cardiac surgery.Trial registration numberPROSPERO CRD42015027696.

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