scholarly journals Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data

2021 ◽  
pp. neurintsurg-2020-016680
Author(s):  
Johannes Kaesmacher ◽  
Thomas Raphael Meinel ◽  
Christoph Kurmann ◽  
Osama O Zaidat ◽  
Alicia C Castonguay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Data ◽  
Mechanical Thrombectomy ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Random Effect ◽  
Effect Estimate ◽  
Safety And Efficacy ◽  
Increased Risk ◽  
Secondary Endpoints

BackgroundAchieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse.MethodsWe performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin Scale ≤2, mortality at 90 days).ResultsThe search identified six observational cohort studies and three observational datasets of MT randomized-controlled trial data reporting on IA fibrinolytics with MT as compared with MT alone, including 2797 patients (405 with additional IA fibrinolytics (100 urokinase (uPA), 305 tissue plasminogen activator (tPA)) and 2392 patients without IA fibrinolytics). Of 405 MT patients treated with additional IA fibrinolytics, 209 (51.6%) received prior intravenous tPA. We did not observe an increased risk of sICH after administration of IA fibrinolytics as adjunct to MT (OR 1.06, 95% CI 0.64 to 1.76), nor excess mortality (0.81, 95% CI 0.60 to 1.08). Although the mode of reporting was heterogeneous, some studies observed improved reperfusion after IA fibrinolytics.ConclusionThe quality of evidence regarding peri-interventional administration of IA fibrinolytics in MT is low and limited to observational data. In highly selected patients, no increase in sICH was observed, but there is large uncertainty.

scholarly journals The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Peter Cox ◽  
Sonal Gupta ◽  
Sizheng Steven Zhao ◽  
David M. Hughes
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Small Sample ◽  
Future Research ◽  
Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

scholarly journals Cancer Incidence and Mortality among Petroleum Industry Workers and Residents Living in Oil Producing Communities: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (8) ◽  
pp. 4343
Author(s):  
Felix M. Onyije ◽  
Bayan Hosseini ◽  
Kayo Togawa ◽  
Joachim Schüz ◽  
Ann Olsson
Keyword(s):  
Systematic Review ◽  
Childhood Leukemia ◽  
Meta Analysis ◽  
Random Effect ◽  
Petroleum Industry ◽  
Occupational Exposures ◽  
Increased Risk ◽  
Incidence And Mortality ◽  
Exposed Workers ◽  
Stratified Analysis

Petroleum extraction and refining are major sources of various occupational exposures and of air pollution and may therefore contribute to the global cancer burden. This systematic review and meta-analysis is aimed at evaluating the cancer risk in petroleum-exposed workers and in residents living near petroleum facilities. Relevant studies were identified and retrieved through PubMed and Web of Science databases. Summary effect size (ES) and 95% confidence intervals (CI) were analysed using random effect models, and heterogeneity across studies was assessed (I2). Overall, petroleum industry work was associated with an increased risk of mesothelioma (ES = 2.09, CI: 1.58–2.76), skin melanoma (ES = 1.34, CI: 1.06–1.70 multiple myeloma (ES =1.81, CI: 1.28–2.55), and cancers of the prostate (ES = 1.13, Cl: 1.05–1.22) and urinary bladder (ES = 1.25, CI: 1.09–1.43) and a decreased risk of cancers of the esophagus, stomach, colon, rectum, and pancreas. Offshore petroleum work was associated with an increased risk of lung cancer (ES = 1.20; 95% CI: 1.03–1.39) and leukemia (ES = 1.47; 95% CI: 1.12–1.92) in stratified analysis. Residential proximity to petroleum facilities was associated with childhood leukemia (ES = 1.90, CI: 1.34–2.70). Very few studies examined specific exposures among petroleum industry workers or residents living in oil producing communities. The present review warrants further studies on specific exposure levels and pathways among petroleum-exposed workers and residents living near petroleum facilities.

scholarly journals Association between Oral Contraceptives and cutaneous melanoma: a systematic review and metanalysis

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Giacchetta ◽  
M Chiavarini ◽  
G Naldini ◽  
R Fabiani
Keyword(s):  
Systematic Review ◽  
Malignant Melanoma ◽  
Publication Bias ◽  
Oral Contraceptives ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cutaneous Malignant Melanoma ◽  
Hormonal Factors ◽  
Increased Risk

Abstract Background The probability of developing invasive cutaneous malignant melanoma (CMM) is higher in women than in men up until the age of 49. Several studies investigated the association between hormonal factors and CMM. The aim of this systematic review and meta-analysis is to summarize the evidence on the association between Oral Contraceptives (OC) and the risk of CMM. Methods This review and meta-analysis follow the PRISMA guidelines. A systematic literature search was conducted on Medline and Web of Science until December 2019. Studies were eligible if reported a risk estimate for the association between OC and CMM. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using random effect model. Results The results of the pooled analysis of all 32 studies showed no significant association between OC and the risk of CMM (OR 1.02; 95% CI 0.94-1.11; I2=39.32%, p = 0.013). The stratified analyses by study design found no significant association between OC and the risk of CMM neither in the 18 case-control studies (OR 1.02; 95% CI 0.87-1.21; I2=56.91%, p = 0.002) nor in the 14 cohort studies (OR 1.04; 95% CI 0.98-1.11; I2=0.00%, p = 0.557). No significant publication bias could be detected by Egger's test or Begg's test. Conclusions This meta-analysis of available literature suggests no significant association between OC and the risk of developing CMM. Further investigations are needed to evaluate the possible relationship of OC use and other hormonal factors potentially contributing to the increased risk of CMM in women during their reproductive years. Key messages Oral contraceptives (OC) do not significantly contribute to the risk of Cutaneous Malignant Melanoma (CMM). Further studies are needed to investigate the potential role of other hormonal factors in the increased probability of developing CMM in women during their reproductive years.

scholarly journals Cerebral microbleeds and risk of adverse outcomes in patients with atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Corica ◽  
G.F Romiti ◽  
V Raparelli ◽  
R Cangemi ◽  
S Basili ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Random Effect ◽  
Adverse Outcomes ◽  
Cerebral Microbleeds ◽  
Funding Sources ◽  
Conflicting Evidence ◽  
Pooled Prevalence ◽  
Increased Risk

Abstract Background Long-term anticoagulation in patients with atrial fibrillation (AF) imposes a careful balance between the thromboembolic and hemorrhagic risks. An association between cerebral microbleeds (CMBs) and an increased risk of intracranial hemorrhage (ICH) has already been described; however, conflicting evidence exist on the association with ischemic stroke (IS). Although CMBs are often observed in AF patients, the actual prevalence and the magnitude of the risk of adverse events in patients with CMBs is unclear. Purpose We aimed to estimate the pooled prevalence of CMBs in patients with AF through a systematic review and meta-analysis of the literature. Additionally, we evaluated the risk of ICH and IS according to the presence and burden of CMBs. Methods We perform a systematic search on PubMed and EMBASE from inception to 6th March 2021. We included all studies reporting the prevalence of CMBs, the incidence of ICH and/or IS in AF by presence of CMBs. Pooled prevalence and odds ratios (OR), along with their 95% Confidence Intervals (CI), were computed using random-effect models; we also calculated 95% Prediction Intervals (PI) for each outcome investigated. Additionally, we performed subgroup analyses according to the number and localization of CMBs. Results We retrieved 562 records from the literature search, and 17 studies were finally included. Pooled prevalence of CMBs in AF population was 28.3% (95% CI: 23.8%-33.4%; 95% PI: 12.2%-52.9%, Figure 1). Individuals with CMBs showed a higher risk of both ICH (OR: 3.04, 95% CI: 1.83–5.06) and IS (OR: 1.78, 95% CI: 1.26–2.49). Moreover, patients with more than 5 CMBs, as well as patients with both lobar and mixed CMBs, showed a higher risk of ICH. Conclusions CMBs were found in 28.3% of AF patients, with 95% PIs indicating a potentially higher prevalence. Moreover, CMBs were associated with an increased risk of both ICH and IS, with the effect potentially modulated by their number and localization. CMBs may represent an important and often overlooked risk factor for adverse outcomes in patients with AF. FUNDunding Acknowledgement Type of funding sources: None. Prevalence of CMBs in patients with AF

scholarly journals Post-natalizumab disease reactivation in multiple sclerosis: systematic review and meta-analysis

2019 ◽  
Vol 12 ◽  
pp. 175628641983780 ◽  
Author(s):  
Luca Prosperini ◽  
Revere P. Kinkel ◽  
Augusto A. Miravalle ◽  
Pietro Iaffaldano ◽  
Simone Fantaccini
Keyword(s):  
Multiple Sclerosis ◽  
Systematic Review ◽  
Disease Activity ◽  
Meta Analysis ◽  
Random Effect ◽  
Patient Characteristics ◽  
Increased Risk ◽  
Disease Reactivation ◽  
Definition Of ◽  
High Level

Background: Natalizumab (NTZ) is sometimes discontinued in patients with multiple sclerosis, mainly due to concerns about the risk of progressive multifocal leukoencephalopathy. However, NTZ interruption may result in recrudescence of disease activity. Objective: The objective of this study was to summarize the available evidence about NTZ discontinuation and to identify which patients will experience post-NTZ disease reactivation through meta-analysis of existing literature data. Methods: PubMed was searched for articles reporting the effects of NTZ withdrawal in adult patients (⩾18 years) with relapsing–remitting multiple sclerosis (RRMS). Definition of disease activity following NTZ discontinuation, proportion of patients who experienced post-NTZ disease reactivation, and timing to NTZ discontinuation to disease reactivation were systematically reviewed. A generic inverse variance with random effect was used to calculate the weighted effect of patients’ clinical characteristics on the risk of post-NTZ disease reactivation, defined as the occurrence of at least one relapse. Results: The original search identified 205 publications. Thirty-five articles were included in the systematic review. We found a high level of heterogeneity across studies in terms of sample size (10 to 1866 patients), baseline patient characteristics, follow up (1–24 months), outcome measures (clinical and/or radiological), and definition of post-NTZ disease reactivation or rebound. Clinical relapses were observed in 9–80% of patients and peaked at 4–7 months, whereas radiological disease activity was observed in 7–87% of patients starting at 6 weeks following NTZ discontinuation. The meta-analysis of six articles, yielding a total of 1183 patients, revealed that younger age, higher number of relapses and gadolinium-enhanced lesions before treatment start, and fewer NTZ infusions were associated with increased risk for post-NTZ disease reactivation ( p ⩽ 0.05). Conclusions: Results from the present review and meta-analysis can help to profile patients who are at greater risk of post-NTZ disease reactivation. However, potential reporting bias and variability in selected studies should be taken into account when interpreting our data.

scholarly journals Thromboembolic and hemorrhagic risks after vaccination against SARS-CoV-2: a systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Noppacharn Uaprasert ◽  
Krissana Panrong ◽  
Ponlapat Rojnuckarin ◽  
Thita Chiasakul
Keyword(s):  
Systematic Review ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Vaccine Hesitancy ◽  
Bleeding Events ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Hemorrhagic Events ◽  
Estimated Risk ◽  
Low Incidence

Abstract Background Thromboembolic and bleeding events after vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are major public concerns leading to vaccine hesitancy. Due to low incidence, an individual randomized controlled trial (RCT) is underpowered to determine whether SARS-CoV-2 vaccines increase the risks of thromboembolism and hemorrhage. Methods We performed a literature search using PubMed, EMBASE, Cochrane, medRxiv databases, and reference lists of relevant articles to identify RCTs that reported thromboembolic, hemorrhagic events, and thromboembolism/hemorrhage-related death after SARS-CoV-2 vaccination. The primary aim of this systematic review and meta-analysis was to estimate the pooled thromboembolic risk related to SARS-CoV-2 vaccines compared to placebo. The secondary outcomes included estimating the risks of arterial thromboembolism (ATE), venous thromboembolisms (VTE), hemorrhage, thrombocytopenia, and thromboembolism/hemorrhage-related death. Results Eight RCTs of 4 vaccine platforms comprised of 195,196 participants were retrieved. SARS-CoV-2 vaccines were not associated with an increased risk of overall thromboembolism (risk ratio [RR], 1.14; 95% CI [confidence interval], 0.61–2.14; I2 = 35%), ATE (RR, 0.97; 95% CI, 0.46–2.06; I2 = 21%), VTE (RR, 1.47; 95% CI, 0.72–2.99; I2 = 0%), hemorrhage (RR, 0.97; 95% CI, 0.35–2.68; I2 = 0), and thromboembolism/hemorrhage-related death (RR, 0.53; 95% CI, 0.16–1.79; I2 = 0). Compared to the baseline estimated risk of these outcomes in participants administered placebos, the risk differences with vaccines were very small and not statistically significant. These findings were consistent in the subgroup analysis across 4 vaccine platforms. Conclusion Vaccines against SARS-CoV-2 are not associated with an increased risk of thromboembolism, hemorrhage, and thromboembolism/hemorrhage-related death.

scholarly journals Prevalence, awareness and control of hypertension in Malaysia 1980 – 2017: A Systematic Review and Meta-Analysis

2019 ◽  
Author(s):  
Zhen Yee Chow ◽  
Soo Man Jun ◽  
Siew Mooi Ching ◽  
Chun Han Tan ◽  
Kai Wei Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Public Health Problem ◽  
High Morbidity ◽  
Hypertension Status ◽  
Increased Risk ◽  
And Control

AbstractBackgroundHypertension is a common public health problem worldwide and is a well-known risk factor for increased risk of cardiovascular diseases, contributing to high morbidity and mortality. However, there is no systematic review and meta-analysis that has been done in a multi-ethnic population like Malaysia. This systematic review aims to determine the trend in prevalence, awareness and control of hypertension in Malaysia.MethodsSystematic searches were conducted in PubMed, Scopus, Ovid, Cumulative Index to Nursing and Allied Health Literature, Malaysian Medical Repository and Malaysia Citation Index published between 1980 and 2017. All original articles in English were included. Studies included were those on adults aged 18 years and above. Studies of prevalence in children and adolescents and pregnancy related hypertension were excluded. Two authors independently reviewed the studies, carried out data extraction and performed quality assessment. Heterogeneity between studies and publication bias was assessed and effect size was pooled by the random effect model.ResultsFifty-six studies with a total of 241,796 subjects were included. The prevalence of hypertension throughout Malaysia varied (I2= 99.3%). The overall pooled prevalence of hypertension over the past 4 decades was 28.2% in adults aged 18 years and older (95% CI: 26.1 – 33.3) and the prevalence in those 30 years and older was 40.0% (95% CI: 35.3-44.8).For subgroup analysis, the prevalence of hypertension in male aged 18 and above was 31.4% (95% CI: 26.5 - 36.2) and 27.8% in female (95% CI: 20.7 – 34.9). The prevalence of hypertension among the ethnic groups aged 18 years and above were 37.3% in Malays (95% CI: 32.9 – 41.7); 36.4% in Chinese (95% CI 31.6 - 41.2) and 34.8% in Indians (95% CI: 31.2-38.4). The prevalence of hypertension was the lowest in the 1980s (16.2%, 95% CI: 13.4-19.0%), increases up to 36.8% in the 1990s (95% CI: 6.1-67.5), then came down to 28.7% (95% CI: 21.7-35.8) in the 2000s and 29.2% (95% CI: 24.0-34.4) in the 2010s. The prevalence of awareness was 38.7% (95% CI: 31.7 – 45.8) whereas the control of hypertension of those on treatment was 33.3% (95% CI: 28.4 – 38.2).ConclusionThree in 10 adults aged 18 years old and above have hypertension, whereas four in 10 adults aged 30 years old and above have hypertension. Four out of 10 are aware of their hypertension status and only one-third of them who were under treatment achieved control of their hypertension. Concerted efforts by policymakers and healthcare professionals to improve the awareness and control of hypertension should be of high priority.

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