Thromboembolic Events, Recurrent Gastrointestinal Bleeding and Mortality after Resuming Anticoagulant Following Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

IMPORTANCE: Gastrointestinal bleeding is one of the most common sites of bleeding complicated by anticoagulant therapy. Patients with anticoagulant-associated gastrointestinal (GI) bleeding are at risk of both thromboembolic events after anticoagulant interruption and recurrent bleeding following anticoagulant resumption. OBJECTIVE: To determine the risk of thromboembolism, recurrent GI bleeding and mortality for long-term anticoagulated patients who experienced GI bleeding. DATA SOURCES: We searched MEDLINE, EMBASE and CENTRAL from inception-July 2014, conferences abstracts (January 2006-July 2014) and www.clinicaltrials.gov up to the last week of January 2014 with no language restriction. STUDY SELECTION: Randomized controlled trials and cohort studies DATA EXTRACTION AND SYNTHESIS: Two reviewers independently performed study selection, data extraction and study quality assessment. MAIN OUTCOMES AND MEASURES: Selected outcomes were thromboembolic events, recurrent gastrointestinal bleeding and all-cause mortality. RESULTS: A total of 6 studies were included in the qualitative analysis and 2 studies in the quantitative analysis. Thromboembolic events occurred in 92 of 984 patients (9.34%) who resumed warfarin and in 147 of 895 (16.4%) patients who did not. The resumption of warfarin was associated with a significant reduction in thromboembolic event (HR 0.65 [95% CI, 0.54 to 0.78], p < 0.001, I2=90%) Recurrent GI bleeding occurred in 101 of 954 (10.59%) patients who restarted warfarin and in 40 of 895 (4.47%) patients who did not. There was no statistically significant increase in recurrent GI bleeding for patients who restarted warfarin compared to those who did not (HR 1.19 [95% CI, 0.95 to 1.48], p = 0.13, I2 = 0%). Death occurred in 203 of 984 (20.63%) patients who resumed warfarin and 316 of 896 (35.27%) patients who did not resume warfarin. Resumption of warfarin was associated with significant reduction in mortality (HR 0.64 [95% CI, 0.54 to 76], p <0.01, I2 = 75%). CONCLUSIONS AND RELEVANCE: This meta-analysis demonstrates that resumption of warfarin following interruption due to GI bleeding is associated with a reduction in thromboembolic events and mortality without a significantly increased risk of recurrent GI bleeding. Figure 1 Forrest plot of the estimate effect of thromboembolic event, recurrent gastrointestinal bleeding and mortality in patient who resumed anticoagulant versus patients who did no resume Figure 1. Forrest plot of the estimate effect of thromboembolic event, recurrent gastrointestinal bleeding and mortality in patient who resumed anticoagulant versus patients who did no resume Disclosures Crowther: Leo Pharma: Membership on an entity's Board of Directors or advisory committees, Research Funding; CSL Behring: Speakers Bureau; Boehriniger Ingelheim: Consultancy; Shire: Speakers Bureau; Celgene: Speakers Bureau; Bayer: Speakers Bureau; Asahi Kasai: Membership on an entity's Board of Directors or advisory committees; Portola: Membership on an entity's Board of Directors or advisory committees; Viropharma: Membership on an entity's Board of Directors or advisory committees.

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Thromboembolic events, recurrent bleeding and mortality after resuming anticoagulant following gastrointestinal bleeding

Thrombosis and Haemostasis ◽

10.1160/th15-01-0063 ◽

2015 ◽

Vol 114 (10) ◽

pp. 819-825 ◽

Cited By ~ 44

Author(s):

Chatree Chai-Adisaksopha ◽

Christopher Hillis ◽

Manuel Monreal ◽

Daniel Witt ◽

Mark Crowther

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Anticoagulation Therapy ◽

Phase Iii ◽

Recurrent Bleeding ◽

Thromboembolic Events ◽

Gi Bleeding ◽

Study Selection ◽

Language Restriction ◽

Randomised Controlled

SummaryGastrointestinal (GI) bleeding commonly complicates anticoagulant therapy. We aimed to systematically review the published literature to determine the risk of thromboembolism, recurrent GI bleeding and mortality for patients on long-term anticoagulation who experience GI bleeding based on whether anticoagulation therapy was resumed. We performed a systematic review of phase III randomised controlled trials and cohort studies in patients with atrial fibrillation or venous thromboembolism who received oral anticoagulant. We searched MEDLINE, EMBASE and CENTRAL (from 1996-July 2014), conferences abstracts (from January 2006-July 2014) and www.clinicaltrials.gov (up to the last week of July 2014) with no language restriction. Two reviewers independently performed study selection, data extraction and study quality assessment. A total of three studies were included in the meta-analysis. The resumption of warfarin was associated with a significant reduction in thromboembolic events (hazard ratio [HR] 0.68, 95 % confidence interval [CI] 0.52 to 0.88, p < 0.004, I2=82 %). There was an increase in recurrent GI bleeding but not statistically significant for patients who restarted warfarin compared to those who did not (HR 1.20, 95 % CI 0.97 to 1.48, p = 0.10, I2 = 0 %). Resumption of warfarin was associated with significant reduction in mortality (HR 0.76, 95 % CI 0.66 to 0.88, p < 0.001, I2 = 87 %). This meta-analysis demonstrates that resumption of warfarin following interruption due to GI bleeding is associated with a reduction in thromboembolic events and mortality without a statistically significant increase in recurrent GI bleeding.Institution where the work was performed: McMaster University, Hamilton, Ontario, Canada.

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Risk of Gastrointestinal Bleeding on Treatment With Statin Alone or With Concomitant Administration of Warfarin: A Systematic Review and Meta-analysis of 5.3 Million Participants

Annals of Pharmacotherapy ◽

10.1177/10600280211049727 ◽

2021 ◽

pp. 106002802110497

Author(s):

Akshaya Srikanth Bhagavathula ◽

Kota Vidyasaga ◽

Eyob Alemayehu Gebreyohannes ◽

Wubshet Tesfaye

Keyword(s):

Gastrointestinal Bleeding ◽

Observational Studies ◽

Data Extraction ◽

Meta Analysis ◽

Concomitant Administration ◽

Pooled Analysis ◽

Data Synthesis ◽

Study Selection ◽

Statin Monotherapy ◽

Statin Use

Objective: This study aimed to comprehensively evaluate the risk of gastrointestinal bleeding (GIB) with statin monotherapy or with concomitant warfarin use. Data Sources: PubMed, Web of Science, and EMBASE (via Scopus) were searched for observational studies that reported the risk of GIB in adults on statin therapy or with concomitant warfarin use until August 28, 2021. Study Selection and Data Extraction: Observational studies evaluating the risk of GIB in adults (age >18 years) on statin medication or concomitant use with warfarin were included. Data Synthesis: In all, 14 studies with a total of 5 235 123 participants, reporting 48 677 GIB events (43 734 from statin users and 4943 from users of statin combined with warfarin), were included in the analyses. The pooled analysis revealed no difference in the risk of GIB with statin monotherapy (relative risk [RR]: 0.65; 95% CI: 0.42-1.02) or concomitant statin + warfarin use (RR: 0.97; 95% CI: 0.91-1.02). Prior use of statin was not associated with GIB risk (RR: 0.88; 95% CI: 0.63-1.22), whereas a shorter duration of statin use (<5 years) was associated with a lower risk of GIB (RR: 0.42; 95% CI: 0.18-0.97). Relevance to Patient Care and Clinical Practice: This analysis provides strong evidence on the association between statin use (with/without warfarin) and risk of GIB. Conclusion: Statin alone or combined with warfarin was not significantly associated with either an increased or decreased risk of GIB. The GIB risk was significantly lower when statins were used for a short duration (<5 years). The putative relationship between statins and GIB in warfarin users warrant further investigation.

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Subsegmental Pulmonary Embolism Diagnosed by Computed Tomography: Incidence and Clinical Implications. A Systematic Review and Meta-Analysis of the Management Outcome Studies.

Blood ◽

10.1182/blood.v114.22.4002.4002 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4002-4002

Author(s):

Marc Carrier ◽

Marc Righini ◽

Phil Wells ◽

Arnaud Perrier ◽

David Anderson ◽

...

Keyword(s):

Research Funding ◽

Data Extraction ◽

Meta Analysis ◽

Pulmonary Arteries ◽

Controlled Trials ◽

Advisory Committees ◽

Diagnostic Strategies ◽

Study Selection ◽

Literature Search Strategy ◽

Multiple Detectors

Abstract Abstract 4002 Poster Board III-938 Background Multiple-detectors CTPA appears to have a higher sensitivity for PE as compared to single-detector CTPA. In particular, multiple-detectors CTPA allows better visualization of segmental and subsegmental pulmonary arteries, hence the proportion of patients with suspected PE in whom isolated subsegmental thrombus are reported might be higher using multiple-detectors CTPA. The clinical significance of subsegmental PE is unknown. In the PIOPED study, PE limited to subsegmental pulmonary arteries were most prevalent among patients with low-probability ventilation/perfusion (V/Q) scans. Patients with non diagnostic (low or intermediate probability) V/Q scans can be safely managed without anticoagulation. Nonetheless, patients with isolated subsegmental PE detected on CTPA are more commonly receiving anticoagulation than not. Purpose To determine whether multiple-detectors CTPA increases the proportion of PE diagnosis limited to subsegmental arteries and to assess the safety of diagnostic strategies based on CTPA. Data Source: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Study Selection Twenty four articles met all the inclusions criteria (21 prospective cohort studies; 3 randomized controlled trials). Data extraction Two reviewers independently extracted data onto standardized forms. Data Synthesis A total of 2674 patients with suspected PE were included in the analyses. Of these, 1140 and 1534 patients underwent a single and multiple-detectors CTPA respectively. Conclusion The use of multiple-detectors CTPA in diagnostic strategies for PE appears to increase the proportion of patients diagnosed with subsegmental PE with comparable outcomes in patients with negative tests. This suggests that patients with subsegmental PE appear to not require anticoagulation. Disclosures: Rodger: Biomerieux: Research Funding; Boehringer Ingelheim: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Pfizer: Research Funding; Leo Pharma: Research Funding; Bayer: Research Funding; GTC Therapeutics: Research Funding.

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Thrombosis in Immune Thrombocytopenia Patients with Antiphospholipid Antibodies: A Meta-Analysis

Blood ◽

10.1182/blood.v126.23.1051.1051 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1051-1051

Author(s):

Guillaume Moulis ◽

Alexandra Audermard-Verger ◽

Laurent Arnaud ◽

Cécile Luxembourger ◽

François Montastruc ◽

...

Keyword(s):

Venous Thrombosis ◽

Board Of Directors ◽

Antiphospholipid Antibodies ◽

Research Funding ◽

Immune Thrombocytopenia ◽

Data Extraction ◽

Meta Analysis ◽

Random Effect ◽

Sensitivity Analyses ◽

Advisory Committees

Abstract Background: Thrombosis during immune thrombocytopenia (ITP) management is a critical issue. Among suspected risk factors for thrombosis in ITP patients, the role of antiphospholipid antibodies (aPL) is controversial. We performed a systematic review and a meta-analysis to investigate risk of thrombosis with lupus anticoagulant (LA), anticardiolipin (aCL) and anti-β2GP1 antibodies in primary ITP. Methods: Literature search was computed on Medline, Cochrane and ISI Web of Sciences by two independent investigators from January 1st 1980 to December 31st 2014. Unpublished studies were searched in meeting abstracts of the American Society of Hematology, the European Haematology Association, the American College of Rheumatology and the European League Against Rheumatism. Inclusion criteria were observational studies including primary ITP patients where presence of aPL was documented (LA, aCL or anti-β2GP1 antibodies). We assessed the occurrence of thrombotic events in these studies. Two investigators performed data extraction. All authors were contacted in order to confirm or provide complementary data if needed. Study quality was assessed using the NewCastle-Ottawa (NOS) scale. The main analysis assessed the risk of all thromboses (arterial or venous) associated with the presence of LA, aCL or anti-β2GP1 antibodies. Sensitivity analyses were performed, restricted to the best quality studies. We also also stratified the risk of arterial and venous thrombosis separately. Random effect (Der Simonian & Laird) models were used. Heterogeneity was assessed using the I2 index. Odds ratio (OR) and their 95% confidence intervals (95%CI) were computed. Publication bias was searched using Egger's test and funnel plot. Results: Searching in electronic databases retrieved 776 citations, completed by 12 additional studies from unpublished literature. Out of them, 44 studies were identified for a full-length text review. Eventually, 10 cohort studies totalizing 1010 patients were selected (9 with LA, 6 with aCL, 2 with anti-β2GP1 antibody dosages). Five studies were prospective and 5 retrospective. The median NOS score was 6 (range: 4-8). The pooled OR for the risk of all thromboses associated with LA positivity was 6.11, 95%CI [3.40-10.99] (I2 =0%, Egger's test: p=0.37). It was 2.13, 95%CI [1.11-4.12] with aCL (I2 =0%, Egger's test: p=0.14). Sensitivity analyses restricted to studies with quality score ≥6 led to similar results. The OR for arterial thrombosis was 5.52, 95%CI [2.40-12.70] with LA and 2.12, 95%CI [0.84-5.33] with aCL. The OR for venous thrombosis was 5.13, 95%CI [2.31-11.40] with LA and 2.00, 95%CI [0.83-4.81] with aCL. Only two studies assessed the risk of thrombosis associated with anti-β2GP1 antibody positivity, with high heterogeneity (I2 =81%). Consequently, no pooled OR was computed. Conclusions: This meta-analysis demonstrates that aPL positivity in ITP patients is a risk factor for thrombosis. The risk was three times higher with LA than with aCL. It was similar for arterial and venous thromboses. For practicing clinicians, our results imply that systematic aPL determinations should be performed in ITP, since aPL positivity and associated thrombosis risk should influence the choice of treatment. Disclosures Michel: Roche: Research Funding; GSK: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; AMGEN: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees. Godeau:Roche: Research Funding; Amgen: Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

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Warfarin Resumption after Intracranial Hemorrhage: A Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood.v128.22.3821.3821 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3821-3821

Author(s):

Chatree Chai-Adisaksopha ◽

Christopher M Hillis ◽

Daniel M. Witt ◽

Sam Schulman ◽

Mark Crowther ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Board Of Directors ◽

Intracranial Hemorrhage ◽

Research Funding ◽

Meta Analysis ◽

Forest Plot ◽

Thromboembolic Events ◽

Advisory Committees ◽

All Cause Mortality

Abstract Objective: To assess the effect of warfarin resumption in patients who experienced warfarin-associated intracranial hemorrhage. Study design: Systematic review and meta-analysis Data sources:We searched MEDLINE (1966 to July 2016), EMBASE (1980 to July 2016) and Cochrane Library electronic database (up to July 2016). Inclusion criteria:Studies were eligible for inclusion if (1) they were randomized controlled trials, prospective cohort or retrospective cohort studies, (2) studies that included adult patients (≥18 years), (3) studies that investigated the patients who experienced warfarin-associated intracranial bleeding, (4) studies that evaluated incidence of recurrent intracranial hemorrhage, thromboembolic events, and all-cause mortality, and (5) studies that reported on patients with warfarin resumption compared to controls (those who did not resume warfarin). Main outcome and measures: Primary outcome was all-cause mortality. Secondary outcomes were ischemic stroke, thromboembolic events, recurrent intracranial hemorrhage and any bleeding. Pooled relative risks (RRs) were calculated using random-effects model. Results: Seven studies were included in the meta-analysis, involving 623 patients who resumed warfarin and 1851 patients who did not resume warfarin after warfarin-associated intracranial hemorrhage. Majority of patients were anticoagulated due to atrial fibrillation, prosthetic heart valve and venous thrombosis. Median time to resume warfarin ranged form 11 days to 39.2 days. Warfarin resumption significantly reduced risk of all-cause mortality (17.06% vs 35.71%), RR 0.50, 95% confidence interval [CI];0.33-0.77, I-square=58.7%, Figure 1. Lower ischemic stroke was observed in patients who resumed warfarin (4.89% vs 7.64%), RR 0.67, 95%CI; 0.45-0.99, I-square=0%, Figure 2. Composite outcome of thromboembolic event was lower but not significant in patients who resumed warfarin (7.35% vs 11.48%), RR 0.61, 95%CI; 0.39-1.07, I-square=50.7%. Recurrent intracranial hemorrhage was not significantly different between patients who resumed and those who did not resume warfarin (7.33% vs 7.39%), RR 1.14, 95%CI; 0.57-2.27, I-square=51.0%, Figure 3. Any bleeding was not significantly different between 2 groups (8.23% vs 8.31%), RR 1.03, 95%CI; 0.73-1.43, I-square=50.4%. Conclusions: Major limitation of this meta-analysis included potential selection bias of the original studies, specifically, patients with better prognosis tended be selected to restart warfarin. In summary, , warfarin resumption after warfarin-associated intracranial hemorrhage was associated with lower risk of all-cause mortality and ischemic stroke without a significant increase in recurrent intracranial hemorrhage. Figure 1 Forest plot of all-cause mortality comparing patients who do and do not resume warfarin. Figure 1. Forest plot of all-cause mortality comparing patients who do and do not resume warfarin. Figure 2 Forest plot of ischemic stroke comparing between patients who do and do not resume warfarin. Figure 2. Forest plot of ischemic stroke comparing between patients who do and do not resume warfarin. Figure 3 Forest plot of recurrent intracranial hemorrhage comparing between patients who resume warfarin versus those who did not resume. Figure 3. Forest plot of recurrent intracranial hemorrhage comparing between patients who resume warfarin versus those who did not resume. Disclosures Hillis: Celgene: Consultancy; Novartis: Consultancy, Honoraria, Research Funding, Speakers Bureau; BMS: Honoraria. Crowther:AKP America: Membership on an entity's Board of Directors or advisory committees; Alexion: Consultancy, Speakers Bureau; Bayer AG: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Boehringer-Ingelheim: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb - Pfizer alliance: Honoraria; Celgene: Honoraria; CSL Behring: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Daichii: Honoraria; Leo Pharma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Octapharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Ortho Clinical Diagnostics: Honoraria; Pfizer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Portola: Consultancy, Membership on an entity's Board of Directors or advisory committees.

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Epidemiology of hepatitis E virus infection in animals in Africa: a systematic review and meta-analysis

BMC Veterinary Research ◽

10.1186/s12917-021-02749-5 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Abdou Fatawou Modiyinji ◽

Jean Joel Bigna ◽

Sebastien Kenmoe ◽

Fredy Brice N. Simo ◽

Marie A. Amougou ◽

...

Keyword(s):

Systematic Review ◽

Hepatitis E Virus ◽

Data Extraction ◽

Meta Analysis ◽

Hepatitis E ◽

Epidemiological Studies ◽

Cross Sectional ◽

Resource Limited ◽

Study Selection ◽

Language Restriction

Abstract Background Hepatitis E virus (HEV) is a major cause of acute hepatitis in humans worldwide and have high burden in the resource-limited countries. Better knowledge of the epidemiology of hepatitis in animals in Africa can help to understand the epidemiology among humans. The objective of this study was to summarize the prevalence of HEV infection and distribution of HEV genotypes among animals in Africa. Methods In this systematic review and meta-analysis, we comprehensively searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to March 22th, 2020 without any language restriction. We considered cross-sectional studies of HEV infection in animals in Africa. Study selection, data extraction, and methodological quality of included studies were done independently by two investigators. Prevalence data were pooled using the random-effects meta-analysis. This review was registered in PROSPERO, CRD42018087684. Results Twenty-five studies (13 species and 6983 animals) were included. The prevalence (antibodies or ribonucleic acid [RNA]) of HEV infection in animals varied widely depending on biological markers of HEV infection measured: 23.4% (95% confidence interval; 12.0–37.2) for anti-HEV immunoglobulins G, 13.1% (3.1–28.3) for anti-HEV immunoglobulins M, and 1.8% (0.2–4.3) for RNA; with substantial heterogeneity. In subgroup analysis, the immunoglobulins G seroprevalence was higher among pigs 37.8% (13.9–65.4). The following HEV genotypes were reported in animals: Rat-HEV genotype 1 (rats and horses), HEV-3 (pigs), HEV-7 (dromedaries), and Bat hepeviruses (bats). Conclusions We found a high prevalence of HEV infection in animals in Africa and HEV genotypes close to that of humans. Some animals in Africa could be the reservoir of HEV, highlighting the need of molecular epidemiological studies for investigating zoonotic transmission.

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Impact of maternal supplementation with probiotics during pregnancy on atopic eczema in childhood – a meta-analysis

British Journal Of Nutrition ◽

10.1017/s0007114511003400 ◽

2011 ◽

Vol 107 (1) ◽

pp. 1-6 ◽

Cited By ~ 77

Author(s):

Katja Doege ◽

Donata Grajecki ◽

Birgit-Christiane Zyriax ◽

Elena Detinkina ◽

Christine zu Eulenburg ◽

...

Keyword(s):

Atopic Eczema ◽

Data Extraction ◽

Meta Analysis ◽

Significant Risk ◽

Controlled Trials ◽

Bacterial Strains ◽

Double Blind ◽

Double Blind Placebo ◽

Study Selection ◽

The Impact

In the present study, we sought to conduct a literature review of randomised, double-blind, placebo-controlled trials, which assessed the impact of probiotics intake during pregnancy on the development of eczema in children. A meta-analysis was conducted for comparison of the development of atopic eczema in children whose mothers took probiotics during pregnancyv.placebo. Study selection, quality appraisal and data extraction were performed independently and in duplicate. The studies were rated according to their size in order to calculate the influence of individual studies on the meta-analysis. A total of seven randomised, double-blind, placebo-controlled trials, published between 2001 and 2009, were selected from the PubMed and Ovid databases for the meta-analysis. The meta-analysis was performed with statistical software Stata/SE11.0. The completed meta-analysis of the seven studies shows a significant risk reduction for atopic eczema in children aged 2–7 years by the administration of probiotics during pregnancy (reduction 5·7 %;P = 0·022). However, this effect was only significant for lactobacilli (reduction 10·6 %;P = 0·045), but not for a mixture of various bacterial strains as probiotics (difference 3·06 %,P = 0·204). In conclusion, the meta-analysis shows that the administration of lactobacilli during pregnancy prevents atopic eczema in children aged from 2 to 7 years. However, a mixture of various bacterial strains does not affect the development of atopic eczema, independent of whether they contain lactobacilli or not.

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Aromatherapy for Symptom Relief in Patients with Burn: A Systematic Review and Meta-Analysis

Medicina ◽

10.3390/medicina58010001 ◽

2021 ◽

Vol 58 (1) ◽

pp. 1

Author(s):

Hye Won Lee ◽

Lin Ang ◽

Jung Tae Kim ◽

Myeong Soo Lee

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Symptom Relief ◽

Routine Care ◽

Risk Of Bias ◽

Review Author ◽

Beneficial Effects ◽

Study Selection ◽

Meta Analyses

Background and Objectives: This review aimed to provide an updated review of evidence regarding the effects of aromatherapy in relieving symptoms of burn injuries, focusing on pain and physiological distress. Materials and Methods: Fifteen databases (including five English databases, four Korean medical databases, and four Iranian databases) and trial registries were searched for studies published between their dates of inception and July 2021. Two review authors individually performed study selection, data extraction, and risk of bias assessment, and any discrepancies were solved by a third review author. Results: Eight RCTs met our inclusion criteria and were analyzed in this updated systematic review. Our meta-analyses revealed that inhaled aromatherapy plus routine care showed beneficial effects in relieving pain after dressing, as compared to placebo plus routine care (p < 0.00001) and routine care alone (p = 0.02). Additionally, inhaled aromatherapy plus routine care (p < 0.00001) and aromatherapy massage plus routine care (p < 0.0001) also showed superior effects in calming anxiety, as compared to routine care alone. None of the included studies reported on AEs. Overall, the risk of bias across the studies was concerning. Conclusions: This updated review and synthesis of the studies had brought a more detailed understanding of the potential application of aromatherapy for easing the pain and anxiety of burn patients.

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Medication-Related Osteonecrosis of the Jaw in Patients Treated Concurrently with Antiresorptive and Antiangiogenic Agents: Systematic Review and Meta-Analysis

Journal of Immunotherapy and Precision Oncology ◽

10.36401/jipo-21-14 ◽

2021 ◽

Author(s):

Akanksha Srivastava ◽

Graciela M. Nogueras Gonzalez ◽

Yimin Geng ◽

Alexander M. Won ◽

Jeffrey Myers ◽

...

Keyword(s):

Relative Risk ◽

Data Extraction ◽

Meta Analysis ◽

Osteonecrosis Of The Jaw ◽

Accurate Estimation ◽

Antiangiogenic Agents ◽

Study Selection ◽

Pooled Prevalence ◽

Exposure Variable ◽

Retrospective Cohort Studies

ABSTRACT Introduction Medication-related osteonecrosis of the jaws (MRONJ) is a known adverse event related to the use of antiresorptive (AR) drugs. More recently, an association between antiangiogenic (AA) drugs and MRONJ has been suggested. This review aimed to investigate the overall prevalence and relative risk of MRONJ in patients treated concurrently with AA and AR agents in comparison with a single AA or AR drug. Methods A review protocol was registered with PROSPERO (ID: CRD42020214244). A systematic literature search, study selection, quality assessment, and data extraction were carried out following PRISMA guidelines. Random-effects meta-analysis models were used to summarize relative estimates for the outcomes, namely prevalence and relative risk of MRONJ. Exposure variable included type of drug, specifically AA and AR agents administered either concurrently or individually. Results Eleven studies were included in the final qualitative and quantitative syntheses. The overall pooled weighted prevalence of MRONJ with concurrent AA-AR drugs was 6% (95% CI: 3–8%), compared with 0% (95% CI: 0–0%) for AA only and 5% (95% CI: 0–10%) for AR only. However, high heterogeneity was noted among included studies. Retrospective cohort studies showed a higher pooled prevalence of 13% (95% CI: 10–17%) for concurrent AA-AR therapy. The pooled risk ratio for MRONJ revealed a risk with concurrent AA-AR drugs 2.57 times as high as with AR only (95% CI: 0.84–7.87); however, this difference was not statistically significant. Concurrent AA-AR drugs had a risk for MRONJ 23.74 times as high as with AA only (95% CI: 3.71–151.92). Conclusions High-quality, representative studies are needed for accurate estimation of relative risk of MRONJ with concurrent AA and AR therapy.

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Association between abnormal maternal serum levels of vitamin B12 and preeclampsia: a systematic review and meta-analysis

Nutrition Reviews ◽

10.1093/nutrit/nuaa096 ◽

2020 ◽

Author(s):

Farzaneh Mardali ◽

Somaye Fatahi ◽

Maryam Alinaghizadeh ◽

Hamed Kord Varkaneh ◽

Mohammad Hassan Sohouli ◽

...

Keyword(s):

Systematic Review ◽

Vitamin B12 ◽

Pregnant Women ◽

Data Extraction ◽

Meta Analysis ◽

Serum Vitamin ◽

Serum Levels ◽

Folic Acid Supplementation ◽

Maternal Serum ◽

Study Selection

Abstract Context Some evidence has shown an association between maternal vitamin B12 levels and the development of preeclampsia in pregnant women, but the relationship between preeclampsia and vitamin B12 is not clear. Objective The aim of this systematic review was to compare serum vitamin B12 levels in women with preeclampsia with those in normotensive pregnant women. Data Sources The PubMed/MEDLINE, Scopus, and Web of Science databases were searched up to August 2019, along with the reference lists of included articles. Study Selection The literature was searched for observational studies that investigated vitamin B12 levels in women with preeclampsia. Data Extraction Data were extracted independently by 2 authors. Data were pooled using a random-effects model. Results Vitamin B12 levels in women with preeclampsia were significantly lower than those in healthy women (mean, −15.24 pg/mL; 95%CI, −27.52 to −2.954; P < 0.015), but heterogeneity between studies was high (I2 = 97.8%; P = 0.0103). Subgroup analyses based on folic acid supplementation, homocysteine concentrations, and gestational age at the time of sampling for vitamin B12 assessment did not identify the sources of heterogeneity. Conclusions Women with preeclampsia had significantly lower vitamin B12 concentrations than normotensive pregnant women.

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