Abstract 5597: Does Warfarin-Based Anticoagulation Improve Outcomes After Acute Myocardial Infarction? A Meta-Analysis of Randomized Clinical Trials

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Salman A Haq ◽  
John F Heitner ◽  
Terrence J Sacchi ◽  
Sorin J Brener
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Principal Component ◽  
Analysis Techniques ◽  
Background Therapy ◽  
Comprehensive Search

Antiplatelet therapy is the principal component of the antithrombotic regimen after acute myocardial infarction (AMI). It remains unclear whether additional routine antithrombin therapy with chronic oral anticoagulation (OAC) improves outcomes. Using the Ovid SP and PubMed databases, we performed a comprehensive search for randomized clinical trials comparing warfarin-containing regimens with or without aspirin (OAC) with non-warfarin-containing regimens with or without aspirin (No OAC) for patients with recent AMI, regardless of reperfusion and adjunctive medical therapies provided during hospital stay. The studies had to provide follow-up for at least one month and have mortality as endpoint. Meta-analysis techniques were employed to calculate the relative risk (RR, fixed effect) for all-cause death at the longest interval of follow-up available. Between 1965 and 2006, 32 studies were identified and 11 were included in the meta-analysis. Among 23,803 patients, 13,070 were assigned to OAC and 10,733 to No OAC. The patients were followed for 3–79 months. Death occurred in 1,199 and 1,162 patients, respectively, RR 1.00 (0.995–1.010) (Figure ). After excluding studies without background aspirin therapy, death occurred in 1,057 and 993 patients, respectively (8 studies, RR 1.00 [0.992–1.008]). OAC with or without aspirin background therapy does not reduce mortality after AMI.

scholarly journals Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

2019 ◽  
Vol 41 (42) ◽  
pp. 4103-4110 ◽  
Author(s):  
Rita Pavasini ◽  
Simone Biscaglia ◽  
Emanuele Barbato ◽  
Matteo Tebaldi ◽  
Dariusz Dudek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

scholarly journals Vitamin E highly cross-linked polyethylene reduces mid-term wear in primary total hip replacement: a meta-analysis and systematic review of randomized clinical trials using radiostereometric analysis

2021 ◽  
Vol 6 (9) ◽  
pp. 759-770
Author(s):  
Zeng Li ◽  
Shuai Xiang ◽  
Cuijiao Wu ◽  
Yingzhen Wang ◽  
Xisheng Weng
Keyword(s):  
Clinical Trials ◽  
Vitamin E ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Wear Properties ◽  
Total Hip

Vitamin E incorporation into highly cross-linked polyethylene (HXLPE) has been introduced to improve wear resistance, and vitamin E incorporated HXLPE (VEPE) has been used in total hip arthroplasty. The aim of this meta-analysis was to investigate the wear properties of VEPE in clinical practice by synthesizing the data provided in randomized clinical trials. The effects on implant stability, functional outcomes and revision rate of VEPE were also compared with those of HXPLE or ultra-high molecular weight polyethylene (UHMWPE). Literature searches were conducted on 1 January 2020 using MEDLINE, EMBASE, Cochrane and ClinicalTrials.gov databases. Randomized controlled trials (RCTs) comparing the aforementioned parameters between VEPE and standard HXPLE/UHMWPE liners were included. Methodological quality and the bias of the included studies were analysed. Meta-analyses were performed using the Review Manager software. Nine RCTs met the eligibility criteria and were included. At early and mid-term follow-up, the vertical penetration and the total penetration of the femoral head were both significantly reduced in the VEPE group. The steady state wear rate of the VEPE group was also remarkably lower. However, at two-year follow-up, significantly increased cup migration was observed in the VEPE group. Moreover, the mid-term clinical outcomes of the VEPE group were worse, while the total revision rates between the two groups were not significantly different. The limited number of included studies may compromise our conclusion regarding clinical outcomes of the VEPE bearing surface. More RCTs with longer follow-up periods are needed to further investigate the effects of VEPE in total hip arthroplasty. Cite this article: EFORT Open Rev 2021;6:759-770. DOI: 10.1302/2058-5241.6.200072

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