scholarly journals Safety and efficacy of dual versus triple antithrombotic therapy (DAT vs TAT) in patients with atrial fibrillation following a PCI: a systematic review and network meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036138
Author(s):  
Renad M Altoukhi ◽  
Reema A Alshouimi ◽  
Shahad M Al Rammah ◽  
Mohammed Y Alzahrani ◽  
Abdulaali R Almutairi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Clinical Trials ◽  
Stent Thrombosis ◽  
Antithrombotic Therapy ◽  
Meta Analysis ◽  
Randomised Clinical Trials ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Triple Antithrombotic Therapy

ObjectiveCreating an appropriate antithrombotic therapy for patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) remains a dilemma. Several clinical trials compared the use of a dual antithrombotic therapy (DAT) regimen with a direct oral anticoagulants including (apixaban, dabigatran, edoxaban or rivaroxaban) and a P2Y12 inhibitor versus a triple antithrombotic therapy (TAT) that includes a vitamin K antagonist plus aspirin and a P2Y12 inhibitor in patients with AF who have undergone PCI. However, there are no head-to-head trials comparing the DAT regimens to each other. We aimed to compare the efficacy and safety of DAT regimens using a network meta-analysis (NMA) approach.DesignA systematic review and NMA of randomised clinical trials.MethodsWe conducted a systematic literature review to identify relevant randomised clinical trials and performed a Bayesian NMA for International Society on Thrombosis and Haemostasis (ISTH) major or clinically relevant non-major (CRNM) bleeding, all-cause mortality, stroke, myocardial infarction (MI) and stent thrombosis outcomes. We used NetMetaXL V.1.6.1 and WinBUGS V.1.4.3 for the NMA and estimated the probability of ranking the treatments based on the surface under the cumulative ranking curve.ResultsThe comparison between DAT regimens showed no significant difference in the safety or efficacy outcomes. Apixaban regimen was ranked first as the preferred therapy in terms of ISTH major or CRNM bleeding and stroke, with a probability of 52% and 54%, respectively. Rivaroxaban regimen was the preferred therapy in terms of MI and stent thrombosis, with a probability of 34% and 27%, respectively. Dabigatran regimen was ranked first in terms of all-cause mortality, with a probability of 28%.ConclusionThe DAT regimens are as safe and effective as TAT regimens. However, ranking probabilities for the best option in the selected outcomes can be used to guide the selection among these agents based on different patients’ conditions.

scholarly journals The Use ofGarciniaExtract (Hydroxycitric Acid) as a Weight loss Supplement: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Igho Onakpoya ◽  
Shao Kang Hung ◽  
Rachel Perry ◽  
Barbara Wider ◽  
Edzard Ernst
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Clinical Trials ◽  
Meta Analysis ◽  
Included Study ◽  
Randomised Clinical Trials ◽  
Hydroxycitric Acid ◽  
Significant Difference ◽  
Uncertain Future ◽  
Using Data

The aim of this systematic review is to examine the efficacy ofGarciniaextract, hydroxycitric acid (HCA) as a weight reduction agent, using data from randomised clinical trials (RCTs). Electronic and nonelectronic searches were conducted to identify relevant articles, with no restrictions in language or time. Two independent reviewers extracted the data and assessed the methodological quality of included studies. Twenty-three eligible trials were identified and twelve were included. Nine trials provided data suitable for statistical pooling. The meta-analysis revealed a small, statistically significant difference in weight loss favouring HCA over placebo (MD: −0.88 kg; 95% CI: −1.75, −0.00). Gastrointestinal adverse events were twice as common in the HCA group compared with placebo in one included study. It is concluded that the RCTs suggest thatGarciniaextracts/HCA can cause short-term weight loss. The magnitude of the effect is small, and the clinical relevance is uncertain. Future trials should be more rigorous and better reported.

scholarly journals The efficacy of Phaseolus vulgaris as a weight-loss supplement: a systematic review and meta-analysis of randomised clinical trials

2011 ◽  
Vol 106 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Igho Onakpoya ◽  
Salsabil Aldaas ◽  
Rohini Terry ◽  
Edzard Ernst
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Clinical Trials ◽  
Meta Analysis ◽  
Poor Quality ◽  
Randomised Clinical Trials ◽  
Herbal Supplement ◽  
Significant Difference ◽  
Present Systematic Review

A variety of dietary supplements are presently available as slimming aids, but their efficacy has not been proven. One such slimming aid is the bean extract, Phaseolusvulgaris. The aim of the present systematic review is to evaluate the evidence for or against the efficacy of P. vulgaris. Electronic and non-electronic searches were conducted to identify relevant human randomised clinical trials (RCT). Hand searches of bibliographies were also conducted. No age, time or language restrictions were imposed. The eligibility of studies was determined by two reviewers independently, and the methodological quality of the included studies was assessed. We identified eleven eligible trials, and six were included. All the included RCT had serious methodological flaws. A meta-analysis revealed a statistically non-significant difference in weight loss between P. vulgaris and placebo groups (mean difference (MD) − 1·77 kg, 95 % CI − 3·33, 0·33). A further meta-analysis revealed a statistically significant reduction in body fat favouring P. vulgaris over placebo (MD − 1·86 kg, 95 % CI − 3·39, − 0·32). Heterogeneity was evident in both analyses. The poor quality of the included RCT prevents us from drawing any firm conclusions about the effects of P. vulgaris supplementation on body weight. Larger and more rigorous trials are needed to objectively assess the effects of this herbal supplement.

scholarly journals Effectiveness of Ivermectin/Doxycycline combination in COVID-19: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Mohammad Ali Omrani ◽  
Amin Salehi-Abargouei ◽  
Behrooz Heydari ◽  
Nazgol Kermanshahi ◽  
Fatemeh Joukar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Hospital Stay ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Viral Clearance ◽  
Control Group ◽  
Clinical Recovery ◽  
Significant Difference ◽  
All Cause Mortality

Abstract BackgroundThis systematic review and meta-analysis aimed to assess the efficacy of the Ivermectin/Doxycycline combination for the treatment of coronavirus disease 2019 (COVID-19).MethodsWe searched PubMed, Web of Science, Scopus, ClinicalTrials.gov, and Google Scholar from database inception to August 26, 2021 for relevant studies. We included studies reporting at least one of the outcomes of interest: all-cause mortality; time to clinical recovery; hospital stay and viral clearance. The logarithm of risk ratios or mean differences and their corresponding standard errors for each outcome were pooled using a random-effects model. The risk of bias was assessed using the Cochrane Collaboration's tool for randomized clinical trials and the Newcastle-Ottawa Scale for cohort studies.ResultsFour randomized clinical trials and one prospective study involving 789 patients, including 399 in the Ivermectin/Doxycycline group and 390 in the control group, were enrolled. The all-cause mortality rate of patients with COVID-19 in the Ivermectin/Doxycycline group was 0.79% (2/253), which was lower than in the control group (3.6%; 9/250). However, the difference was not statistically significant (Log risk ratio=-1.288; 95% CI:-2.671, 0.096; P = 0.068; I2 = 0%). The effect of Ivermectin/Doxycycline on time to clinical recovery was found to be significant (Difference in means =-2.427 days; 95% CI:-4.033, -0.820; P = 0.003, I2 = 91.475%). There is no significant effect of Ivermectin/Doxycycline on hospital stay (Difference in means =-0.379 days; 95% CI:-1.965, 1.208; P = 0.640, I2 = 91.95%) and time to negative PCR or viral clearance (Difference in means =-0.768 days; 95% CI:-1.550, 0.013; P = 0.054, I2 = 91.48%).DiscussionBased on low-quality evidence, this meta-analysis showed that Ivermectin/Doxycycline combination is accompanied with shorter time of clinical recovery in COVID-19 patients. However, it did not reduce all-cause mortality, viral clearance, and hospital stay significantly. Not only the number of the studies are limited but also they ranked methodologically medium to low with limited participants. To assess the exact effective dose and efficacy of this combination therapy, high-quality and large-scale randomized clinical trials are needed.OtherThis study was registered in Prospero (registration number: CRD42021272400). The authors declare they have no competing financial interests.

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