Warm Needle Acupuncture in Primary Osteoporosis Management: A Systematic Review and Meta-Analysis

Background Warm needle acupuncture (WNA) is commonly used in primary osteoporosis (OP) management in China. The evidence of its effectiveness needs to be systematically reviewed. Objective The aim of the meta-analysis was to evaluate whether using WNA alone or combined with conventional medicine benefits primary OP. Methods PubMed, Embase, the Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang and VIP databases were searched from their inception through 30 June 2016. RCTs applying WNA independently or as an adjunct to conventional medicine, compared with conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle and greater trochanter. The secondary outcome was chronic pain measured by VAS score. Meta-analysis was conducted using RevMan V.5.3 software. Results Nine RCTs involving 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favour of increasing BMD of the lumbar vertebrae (mean difference (MD)=0.06, 95% CI 0.03 to 0.08, P<0.001). WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, P<0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, P<0.001) when used alone, and additionally decreased VAS scores (MD=−1.10, 95% CI −1.14 to −1.06, P<0.001) when used as an adjunct to conventional medicine. However, the safety of WNA was not specifically reported. Conclusions WNA may have beneficial effects on BMD and VAS scores of patients with primary OP. However, all included trials were at high risk of bias and of low quality. Further rigorous studies are needed to determine the effectiveness of WNA for primary OP treatment.

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Iris-Claw Intraocular Lens: Anterior Chamber or Retropupillary Implantation? A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina57080785 ◽

2021 ◽

Vol 57 (8) ◽

pp. 785

Author(s):

I-Chia Liang ◽

Yun-Hsiang Chang ◽

Adrián Hernández Hernández Martínez ◽

Chi-Feng Hung

Keyword(s):

Anterior Chamber ◽

Intraocular Lens ◽

Meta Analysis ◽

Secondary Outcome ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled ◽

Cell Counts ◽

Iop Elevation ◽

Iris Claw

Background and Objectives: Iris-claw intraocular lens (ICIOL) could be implanted in the anterior chamber (AC) or retropupillary (RP) in eyes lacking capsular and/or zonular support. Several studies have focused on comparing the efficacy and complications of these two techniques and we designed this research to review the published literatures. Materials and Methods: Peer-reviewed studies were collected through network databases (PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and analyzed. The primary outcome was the standardized mean differences (SMDs) of pre- and post-operative corrected distant visual acuity (CDVA). The secondary outcome was the SMDs of pre- and post-operative intraocular pressure (IOP), endothelial cell counts (ECC), and the odds ratios (ORs) of post-operative IOP elevation and cystoid macular edema (CME). Comprehensive Meta-Analysis software was utilized to conduct statistical analysis. Results: Six studies (one randomized controlled trial and five retrospective case series) were relevant and included a total of 516 eyes (255 and 261 eyes in the AC ICIOL and RP ICIOL groups, respectively). The quantitative analysis showed no significant differences in CDVA (SMD: 0.164, 95% confidence interval (CI): −0.171 to 0.500), ECC (SMD: −0.011, 95% CI: −0.195 to 0.173), and IOP elevation events (OR: 0.797, 95% CI: 0.459 to 1.383). Lesser IOP reduction (SMD: 0.257, 95%CI: 0.023 to 0.490) and a relative increase in the incidence of CME (OR:2.315, 95% CI: 0.950 to 5.637) were observed in the AC ICIOL group compared with RP ICIOL group. Conclusions: Our meta-analysis indicated that AC and RP ICIOL seem to have equivalent visual outcomes. RP ICIOL may perform slightly better with more IOP reduction and lesser CME. More randomized controlled trials, which have higher patient participation and more outcomes are needed to confirm our conclusions.

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The Effect of Kinesitherapy on Bone Mineral Density in Primary Osteoporosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/5074824 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Shanxi Wang ◽

Shuzhen Li ◽

Xing Xie ◽

Juying Xie

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Controlled Trial ◽

Meta Analysis ◽

Cochrane Library ◽

Primary Osteoporosis ◽

Mineral Density ◽

Age Related ◽

Positive Effect ◽

Quality Evidence

Objective. Osteoporosis (OP) is a well-established age-related disease, pathologically characterized by bone microarchitectural deterioration, increased fragility, and low BMD. Primary osteoporosis (POP) is the most common type of OP. Methods. Publications pertaining to the effectiveness of kinesitherapy on BMD in POP from PubMed, SCI, Cochrane Library, Embase, VIP, CNKI, and Wanfang Database were retrieved from their inception to October 2019. Results. A total of 21 studies with 1840 participants were included. The results of the meta-analysis revealed that kinesitherapy plus antiosteoporosis medications had a positive effect on lumbar spine BMD when the duration of intervention was 6 months (MD = 0.11 g/cm2; 95% CI: 0.06–0.15; P<0.0001) or >6 months (MD = 0.04 g/cm2; 95% CI: 0.02–0.06; P<0.0001) compared with antiosteoporosis medications alone. Additional kinesitherapy plus antiosteoporosis medications were associated with improved femoral neck BMD compared with antiosteoporosis medications alone (MD = 0.09 g/cm2; 95% CI: 0.03–0.16; P=0.004). Conclusions. Kinesitherapy plus antiosteoporosis medications significantly improved lumbar spine and femoral neck BMD in the current low-quality evidence. Additional high-quality evidence is required to confirm the effect of kinesitherapy on BMD in patients with POP.

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The Analgesic Effect of Electroencephalographic Neurofeedback for People With Chronic Pain: Protocol for a Systematic Review and Meta-analysis

JMIR Research Protocols ◽

10.2196/22821 ◽

2020 ◽

Vol 9 (10) ◽

pp. e22821

Author(s):

Negin Hesam-Shariati ◽

Wei-Ju Chang ◽

James H McAuley ◽

Andrew Booth ◽

Zina Trost ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Randomized Controlled Trials ◽

Analgesic Effect ◽

Meta Analysis ◽

Secondary Outcome ◽

Placebo Control ◽

Controlled Trials ◽

Cochrane Central Register ◽

Randomized Controlled

Background Chronic pain is a global health problem, affecting around 1 in 5 individuals in the general population. The understanding of the key role of functional brain alterations in the generation of chronic pain has led researchers to focus on pain treatments that target brain activity. Electroencephalographic neurofeedback attempts to modulate the power of maladaptive electroencephalography frequency powers to decrease chronic pain. Although several studies have provided promising evidence, the effect of electroencephalographic neurofeedback on chronic pain is uncertain. Objective This systematic review aims to synthesize the evidence from randomized controlled trials to evaluate the analgesic effect of electroencephalographic neurofeedback. In addition, we will synthesize the findings of nonrandomized studies in a narrative review. Methods We will apply the search strategy in 5 electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycInfo, and CINAHL) for published studies and in clinical trial registries for completed unpublished studies. We will include studies that used electroencephalographic neurofeedback as an intervention for people with chronic pain. Risk-of-bias tools will be used to assess methodological quality of the included studies. We will include randomized controlled trials if they have compared electroencephalographic neurofeedback with any other intervention or placebo control. The data from randomized controlled trials will be aggregated to perform a meta-analysis for quantitative synthesis. The primary outcome measure is pain intensity assessed by self-report scales. Secondary outcome measures include depressive symptoms, anxiety symptoms, and sleep quality measured by self-reported questionnaires. We will investigate the studies for additional outcomes addressing adverse effects and resting-state electroencephalography analysis. Additionally, all types of nonrandomized studies will be included for a narrative synthesis. The intended and unintended effects of nonrandomized studies will be extracted and summarized in a descriptive table. Results Ethics approval is not required for a systematic review, as there will be no patient involvement. The search for this systematic review commenced in July 2020, and we expect to publish the findings in early 2021. Conclusions This systematic review will provide recommendations for researchers and health professionals, as well as people with chronic pain, about the evidence for the analgesic effect of electroencephalographic neurofeedback. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42020177608; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=177608 International Registered Report Identifier (IRRID) PRR1-10.2196/22821

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3,4-diaminopyridine treatment for Lambert-Eaton myasthenic syndrome in adults: a meta-analysis of randomized controlled trials

BMC Neurology ◽

10.1186/s12883-021-02405-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Na Zhang ◽

Daojun Hong ◽

Taohui Ouyang ◽

Wei Meng ◽

Jingwei Huang ◽

...

Keyword(s):

Meta Analysis ◽

Autoimmune Disorder ◽

Placebo Treatment ◽

Secondary Outcome ◽

Controlled Trials ◽

Cochrane Central Register ◽

Central Register ◽

Compound Muscle Action Potentials ◽

Myasthenic Syndrome ◽

Randomised Controlled

Abstract Background Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder of neuromuscular transmission. The objective was to examine the efficacy and safety of 3,4-diaminopyridine (3,4-DAP) in patients with LEMS. Methods We searched several databases to identify relevant studies, including PubMed, EMBASE, Web of Science, MEDLINE, Cochrane Neuromuscular Disease Group Specialized Register and the Cochrane Central Register of Controlled Trials(CENTRAL). The primary outcome, quantitative myasthenia gravis (QMG) score and the secondary outcome, compound muscle action potentials (CMAP) amplitude were pooled by meta-analysis. Results Six randomised controlled trials (RCTs) involving 115 patients with LEMS were included. QMG score showed a significant decrease (improvement) of 2.76 points (95 % CI, -4.08 to -1.45, p < 0.001) after treatment with 3, 4-DAP. Moreover, the overall mean CMAP amplitude improved significantly in LEMS patients with 3, 4-DAP treatment, compared with placebo treatment (mean difference 1.34 mV, 95 % CI, 0.98 to 1.70, p < 0.001). The overall assessment of all included trials showed a low risk of bias and low heterogeneity. Conclusions The pooled results of RCTs demonsrated with moderate to high evidence that 3,4-DAP has a significant effect on LEMS treatment, with improvements in muscle strength score and CMAP amplitude.

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Comparative efficacy of interventions for reducing injection and sexual risk behaviours to prevent HIV in injection drug users: protocol for Bayesian network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-022811 ◽

2019 ◽

Vol 9 (1) ◽

pp. e022811 ◽

Cited By ~ 1

Author(s):

Junjie Lang ◽

Lairun Jin ◽

Yingshui Yao

Keyword(s):

Bayesian Network ◽

Injection Drug Users ◽

Drug Users ◽

Controlled Trial ◽

Meta Analysis ◽

Risk Behaviour ◽

Risk Of Bias ◽

Injection Drug ◽

Secondary Outcome ◽

Cochrane Central Register

IntroductionDrug users are more vulnerable to AIDS than the general population. While several interventions are effective for addressing HIV in injection drug users, no meta-analysis has yet been performed to compare interventions and determine the relative benefits of each. We intend to conduct a Bayesian network meta-analysis to compare all available interventions evaluated by a randomised controlled trial for reducing injection and risky sexual behaviours for the prevention of HIV in injection drug users.Methods and analysisStudies will be retrieved by searching the following databases: MEDLINE, Embase, PsycINFO and Cochrane Central Register of Controlled Trials. The search will be performed between May and July 2018 for the literature published between 1980 and May 2018. Two authors will extract data independently. Primary outcome measures will be injection risk behaviour and HIV risk behaviour. HIV seroconversion, confirmed using an antibody test, will be the secondary outcome. Bayesian network meta-analyses will be conducted using the Markov Chains Monte Carlo method. The Cochrane revised tool, Risk of Bias, will be used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluation will be used to assess evidence quality.Ethics and disseminationThe results of this study will be disseminated at professional conferences and via publications in peer-reviewed journals. This study will not include any confidential personal data or data on human trials; therefore, ethical approval is not required.PROSPERO registration numberCRD42018086999.

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Safety and efficacy of the European Society of Cardiology 0/1-hour algorithm for diagnosis of myocardial infarction: systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2019-316343 ◽

2020 ◽

Vol 106 (13) ◽

pp. 985-991 ◽

Cited By ~ 4

Author(s):

Cho-Han Chiang ◽

Cho-Hung Chiang ◽

Gin Hoong Lee ◽

Weng-Tein Gi ◽

Yuan-Kun Wu ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

European Society ◽

Primary Outcome ◽

Meta Analysis ◽

High Sensitivity ◽

Secondary Outcome ◽

Cochrane Central Register ◽

Registration Number ◽

European Society Of Cardiology

ObjectiveThe European Society of Cardiology (ESC) 0/1 hour algorithm has been primarily validated in Europe, America and Australasia with less knowledge of its performance outside of these settings. We aim to evaluate the performance of the ESC 0/1 hour algorithm across different contexts.MethodsWe searched PubMed, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials for relevant studies published between 1 January 2008 and 31 May 2019. The primary outcome was index myocardial infarction and the secondary outcome was major adverse cardiac event or mortality. A bivariate random-effects meta-analysis was used to derive the pooled estimate of each outcome.ResultsA total of 11 014 patients from 10 cohorts were analysed for the primary outcome. The algorithm based on high-sensitivity cardiac troponin (hs-cTn)T (Roche), hs-cTnI (Abbott) and hs-cTnI (Siemens) had pooled sensitivity of 98.4% (95% CI=95.1% to 99.5%), 98.1% (95% CI=94.6% to 99.3%) and 98.7% (95% CI=97.3% to 99.3%), respectively. The algorithm based on hs-cTnT (Roche) and hs-cTnI (Siemens) had pooled specificity of 91.2% (95% CI=86.0% to 94.6%) and 95.9% (95% CI=94.1% to 97.2%), respectively. Among patients in the rule-out category, the pooled mortality rate at 30 days and at 1 year was 0.1% (95% CI=0.0% to 0.4%) and 0.8% (95% CI=0.5% to 1.2%), respectively. Among patients in the observation zone, the pooled mortality rate was 0.7% (95% CI=0.3% to 1.2%) at 30 days but increased to 8.1% (95% CI=6.1% to 10.4%) at 1 year, comparable to the mortality rate in the rule-in group.ConclusionThe ESC 0/1 hour algorithm has high diagnostic accuracy but may not be sufficiently safe if the 1% miss-rate for myocardial infarction is desired.PROSPERO registration numberCRD42019142280.

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Role of Transcutaneous Electrical Nerve Stimulation in Treating Children With Overactive Bladder From Pooled Analysis of 8 Randomized Controlled Trials

International Neurourology Journal ◽

10.5213/inj.1938232.116 ◽

2020 ◽

Vol 24 (1) ◽

pp. 84-94

Author(s):

Huanqin Cui ◽

Yi Yao ◽

Zhunan Xu ◽

Zhenli Gao ◽

Jitao Wu ◽

...

Keyword(s):

Overactive Bladder ◽

Meta Analysis ◽

Pooled Analysis ◽

Relative Advantage ◽

Control Group ◽

Controlled Trials ◽

Cochrane Central Register ◽

Remarkable Effect ◽

Vas Scores ◽

Voided Volume

Purpose: Transcutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB.Results: Of the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB.Conclusions: TENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.

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The relative effectiveness of psychotherapeutic techniques and delivery modalities for chronic pain: a protocol for a systematic review and network meta-analysis.

HRB Open Research ◽

10.12688/hrbopenres.12953.2 ◽

2020 ◽

Vol 2 ◽

pp. 25

Author(s):

Stephanie Haugh ◽

Laura O'Connor ◽

Brian Slattery ◽

Michelle Hanlon ◽

Jack Flynn ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Psychological Distress ◽

Meta Analysis ◽

Relative Effectiveness ◽

Pain Interference ◽

Secondary Outcome ◽

Future Research ◽

Controlled Trials ◽

Cochrane Central Register

Introduction: There is increasing evidence for the use of psychotherapies, including cognitive behavioural therapy, acceptance and commitment therapy, and mindfulness based stress reduction therapy, as an approach to management of chronic pain. Similarly, online psychotherapeutic interventions have been shown to be efficacious, and to arguably overcome practical barriers associated with traditional face-to-face treatment for chronic pain. This is a protocol for a systematic review and network meta-analysis aiming to evaluate and rank psychotherapies (delivered in person and online) for chronic pain patients. Methods/ design: Four databases, namely the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO will be searched from inception. Randomised controlled trials that have evaluated psychological interventions for pain management delivered online or in person will be included in the review. Data will be independently extracted in duplicate and the Cochrane Collaboration Risk of Bias Tool will be used to assess study quality. Measures of pain interference will be extracted as the primary outcome and measures of psychological distress will be extracted as the secondary outcome. A network meta-analysis will generate indirect comparisons of psychotherapies across treatment trials. Rankings of psychotherapies for chronic pain will be made available. Discussion: A variety of psychotherapies, delivered both online and in person, have been used in an attempt to help manage chronic pain. Although occasional head to head trials have been conducted, little evidence exists to help identify which psychotherapy is most effective in reducing pain interference. The current review will address this gap in the literature and compare the psychotherapies used for internet delivered and in person interventions for chronic pain in relation to the reduction of pain interference and psychological distress. Results will provide a guide for clinicians when determining treatment course and will inform future research into psychotherapies for chronic pain. PROSPERO registration: CRD42016048518 01/11/16

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The scale of neurodegeneration in moderate-to-severe traumatic brain injury: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-019-1208-0 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Bhanu Sharma ◽

Alana T. Changoor ◽

Leanne Monteiro ◽

Brenda Colella ◽

Robin E. A. Green

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Diffusion Tensor ◽

Meta Analysis ◽

Secondary Outcome ◽

Cochrane Central Register ◽

Post Injury ◽

Severe Tbi

Abstract Background Our understanding of recovery after moderate-to-severe traumatic brain injury (TBI) has shifted. Until recently, it was presumed that following a period of acute neurological vulnerability, the brain remained stable in the chronic stages of injury. However, recent research has shown neurodegeneration in the chronic stages of moderate-to-severe TBI, challenging the assumption of neurological stability. While there is extensive evidence that neurodegeneration occurs, debate remains regarding the scale and timing. This systematic review will evaluate the scale and timelines of neurodegeneration in adult patients with moderate-to-severe TBI. Methods Literature searches will be conducted in six electronic databases (from inception onwards), including MEDLINE, EMBASE, PsycINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials. We will include observational studies that examine neurodegenerative changes within a single sample of TBI patients or studies that compare neuroimaging outcomes between TBI patients and healthy controls. Our primary outcome is structural neuroimaging, and our secondary outcome is diffusion tensor imaging for detection of post-injury white matter changes. All screening, data extraction, and study quality appraisal will be performed independently by the same two study members. It is expected that a narrative summary of the literature will be produced. If feasible, we will conduct a random-effects meta-analysis. However, given the expected heterogeneity between studies (with respect to, for example, timing of imaging, regions imaged) we do not expect to perform a meta-analysis; rather, a narrative synthesis of our findings is expected to be performed. Discussion Understanding the scale and timelines of neurodegeneration in moderate-to-severe TBI (as well as which brain areas are most vulnerable to chronic declines) can inform intervention research designed to offset such changes. This may help improve patient outcome following moderate-to-severe TBI and, in turn, reduce the burden of the injury. Systematic review registration PROSPERO CRD42019117548

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Bleeding risk in patients using oral anticoagulants submitted to surgical procedures in dentistry: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2017-019161 ◽

2017 ◽

Vol 7 (12) ◽

pp. e019161 ◽

Cited By ~ 1

Author(s):

Rogério Heládio Lopes Motta ◽

Cristiane de Cássia Bergamaschi ◽

Natalia Karol de Andrade ◽

Caio Chaves Guimaraes ◽

Juliana Cama Ramacciato ◽

...

Keyword(s):

Systematic Review ◽

Surgical Procedures ◽

Meta Analysis ◽

Oral Anticoagulants ◽

Bleeding Risk ◽

Secondary Outcome ◽

Cochrane Central Register ◽

Oral Surgical Procedures ◽

Bleeding Rate ◽

Risk Of Bleeding

IntroductionThe management of patients undergoing oral surgical procedures using anticoagulants raises concerns regarding the risk of bleeding. Bleeding rates in those patients during or after oral surgical procedures are uncertain. The aim of this study will be to determine the bleeding rate during and after oral surgeries in patients using anticoagulants.Methods and analysisA systematic review will be conducted and if appropriate, a meta-analysis of randomised clinical trials evaluating the bleeding risk during and after oral surgical procedures in patients using anticoagulants were selected. The literature search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials, MEDLINE (via Ovid), Embase (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via Ovid), LILACS (SciELO) and CAPES database, without restriction of languages or date of publication. The primary outcome will be the occurrence of local bleeding rate during and after oral surgical procedures, and as secondary outcome, the following complications will be considered: implant failure, healing problems and infections. Groups of two independent reviewers will select the titles and abstracts for full-text eligibility. For eligible studies, the same reviewers will perform data extraction, bias risk assessment and determination of the overall quality of evidence for each of the outcomes using the Grading of Recommendations Assessment, Development and Evaluation classification system. Meta-analysis and subgroup analyses will be conducted, to all outcomes, if appropriate.Ethics and disseminationThe systematic review will be published in a peer-reviewed journal, and brief reports of the review’s findings will be released directly to the intended audience. The results will help dentists in the decision-making process to minimise the risk of bleeding in patients using anticoagulants in their clinical practice.PROSPERO registration numberCRD42017056986.

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