scholarly journals Vitamin K for reversal of excessive vitamin K antagonist anticoagulation: a systematic review and meta-analysis

2019 ◽  
Vol 3 (5) ◽  
pp. 789-796 ◽  
Author(s):  
Rasha Khatib ◽  
Maja Ludwikowska ◽  
Daniel M. Witt ◽  
Jack Ansell ◽  
Nathan P. Clark ◽  
...  
Keyword(s):  
Vitamin K ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
Assessment Development ◽  
Randomized Controlled ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Meta Analyses ◽  
Risk Ratios

Abstract Patients receiving vitamin K antagonists (VKAs) with an international normalized ratio (INR) between 4.5 and 10 are at increased risk of bleeding. We systematically reviewed the literature to evaluate the effectiveness and safety of administering vitamin K in patients receiving VKA therapy with INR between 4.5 and 10 and without bleeding. Medline, Embase, and Cochrane databases were searched for relevant randomized controlled trials in April 2018. Search strategy included terms vitamin K administration and VKA-related terms. Reference lists of relevant studies were reviewed, and experts in the field were contacted for relevant papers. Two investigators independently screened and collected data. Risk ratios (RRs) were calculated, and certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Six studies (1074 participants) were included in the review and meta-analyses. Pooled estimates indicate a nonsignificant increased risk of mortality (RR = 1.42; 95% confidence interval [CI], 0.62-2.47), bleeding (RR = 2.24; 95% CI, 0.81-7.27), and thromboembolism (RR = 1.29; 95% CI, 0.35-4.78) for vitamin K administration, with moderate certainty of the evidence resulting from serious imprecision as CIs included potential for benefit and harm. Patients receiving vitamin K had a nonsignificant increase in the likelihood of reaching goal INR (1.95; 95% CI, 0.88-4.33), with very low certainty of the evidence resulting from serious risk of bias, inconsistency, and imprecision. Our findings indicate that patients on VKA therapy who have an INR between 4.5 and 10.0 without bleeding are not likely to benefit from vitamin K administration in addition to temporary VKA cessation.

scholarly journals Should we Test the Prothrombin Time in Anticoagulated Epistaxis Patients?

2013 ◽  
Vol 4 (1) ◽  
pp. ar.2013.4.0049 ◽  
Author(s):  
Michael B. Soyka ◽  
David Holzmann
Keyword(s):  
Prothrombin Time ◽  
Vitamin K ◽  
Oral Anticoagulation ◽  
Vitamin K Antagonists ◽  
International Normalized Ratio ◽  
Increased Risk

Epistaxis is one of the most frequent emergencies in rhinology. Patients using anticoagulative medication are at increased risk for epistaxis. We evaluated the prothrombin time and the international normalized ratio (INR) in anticoagulated epistaxis patients. Patients suffering from epistaxis were prospectively included in a database and results from prothrombin testing were analyzed in the context of anticoagulation. One hundred sixteen of 591 epistaxis cases were identified to be on oral anticoagulation. The INR was found to be above therapeutic levels in 19 (16%) of these cases. We strongly recommend prothrombin time and INR testing in all epistaxis patients taking any sort of vitamin K antagonists.

scholarly journals Anemia and the Risk of Cognitive Impairment: An Updated Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 (6) ◽  
pp. 777
Author(s):  
Woon-Man Kung ◽  
Sheng-Po Yuan ◽  
Muh-Shi Lin ◽  
Chieh-Chen Wu ◽  
Md. Mohaimenul Islam ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Observational Studies ◽  
Web Of Science ◽  
Meta Analysis ◽  
The Elderly ◽  
Previous Evidence ◽  
Increased Risk ◽  
Meta Analyses ◽  
Risk Ratios

Background: Cognitive impairment is one of the most common, burdensome, and costly disorders in the elderly worldwide. The magnitude of the association between anemia and overall cognitive impairment (OCI) has not been established. Objective: We aimed to update and expand previous evidence of the association between anemia and the risk of OCI. Methods: We conducted an updated systematic review and meta-analysis. We searched electronic databases, including EMBASE, PubMed, and Web of Science for published observational studies and clinical trials between 1 January 1990 and 1 June 2020. We excluded articles that were in the form of a review, letter to editors, short reports, and studies with less than 50 participants. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We estimated summary risk ratios (RRs) with random effects. Results: A total of 20 studies, involving 6558 OCI patients were included. Anemia was significantly associated with an increased risk of OCI (adjusted RR (aRR) 1.39 (95% CI, 1.25–1.55; p < 0.001)). In subgroup analysis, anemia was also associated with an increased risk of all-cause dementia (adjusted RR (aRR), 1.39 (95% CI, 1.23–1.56; p < 0.001)), Alzheimer’s disease [aRR, 1.59 (95% CI, 1.18–2.13; p = 0.002)], and mild cognitive impairment (aRR, 1.36 (95% CI, 1.04–1.78; p = 0.02)). Conclusion: This updated meta-analysis shows that patients with anemia appear to have a nearly 1.39-fold risk of developing OCI than those without anemia. The magnitude of this risk underscores the importance of improving anemia patients’ health outcomes, particularly in elderly patients.

scholarly journals Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Khalid Eljaaly ◽  
Monique R Bidell ◽  
Ronak G Gandhi ◽  
Samah Alshehri ◽  
Mushira A Enani ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Random Effects Models ◽  
Randomized Controlled ◽  
Colistimethate Sodium ◽  
Meta Analyses ◽  
Risk Ratios ◽  
Number Needed To Harm

Abstract Background Nephrotoxicity is a known adverse effect of polymyxin antibiotics, including colistin. Although previous meta-analyses have aimed to characterize colistin-associated nephrotoxicity risk relative to other antibiotics, included studies were observational in nature with high risk of confounding and heterogeneity. We conducted this systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to evaluate the incidence of nephrotoxicity associated with colistin versus minimally nephrotoxic antibiotics. Methods We searched PubMed, EMBASE, Cochrane Library, and 3 trial registries for RCTs comparing the nephrotoxicity of colistin to nonpolymyxin antibiotics. Randomized controlled trials that used aminoglycosides were excluded. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The study outcome was the rate of nephrotoxicity. Results Five RCTs with a total of 377 patients were included. Most patients received colistin for pneumonia in the intensive care unit, and the comparators were β-lactam-based regimens. Colistimethate sodium was dosed at 9 million units/day (300 mg/day of colistin base activity), with administration of a loading dose in 4 studies. The nephrotoxicity incidence in patients who received colistin was 36.2% (95% CI, 23.3% to 51.3%). The nephrotoxicity rate was significantly higher in the colistin arm than comparators (RR, 2.40; 95% CI, 1.47 to 3.91; P ≤ .001; I2 = 0%), and the number needed to harm was 5. Findings persisted upon one-study-removed-analysis. Conclusions This meta-analysis of RCTs found a colistin-associated nephrotoxicity rate of 36.2% and an increase in this risk compared with β-lactam-based regimens by 140%. Colistin should be regarded as a last-line agent and safer alternatives should be considered when possible.

Clinical Outcomes of Different Warfarin Self-care Strategies: A Systematic Reviews and Network Meta-Analysis

2021 ◽  
Author(s):  
Teerapon Dhippayom ◽  
Kansak Boonpattharatthiti ◽  
Treeluck Thammathuros ◽  
Piyameth Dilokthornsakul ◽  
Itsarawan Sakunrag ◽  
...  
Keyword(s):  
Usual Care ◽  
Meta Analysis ◽  
Self Care ◽  
International Normalized Ratio ◽  
Care Group ◽  
Self Testing ◽  
Significant Difference ◽  
Mean Differences ◽  
Meta Analyses ◽  
Risk Ratios

Aim: To compare the effects of different strategies for warfarin self-care. Methods: PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations &Theses, and OpenGrey were searched from inception to May 2020. Randomized controlled trials (RCTs) were included if they explored the effect of warfarin self-care, either patient self-testing (PST) or patient self-management (PSM). Self-care approaches were classified based on our newly created TIP framework (theme, intensity, provider): 1) PST>1/week via e-Health (PST/High/e-Health); 2) PST>1/week by healthcare practitioner (PST/High/HCP); 3) PST<1/week via e-Health (PST/Low/e-Health); 4) PSM>1/week by e-Health (PSM/High/e-Health); 5) PSM>1/week by patient (PSM/High/Pt); 6) PSM<1/week by patient (PSM/Low/Pt); and 7) PSM with flexible frequency by patient (PSM/Vary/Pt). Mean differences (MD) and risk ratios (RR) with 95% confidence interval (CI) were estimated using frequentist network meta-analyses with a random effects model. Results: Fifteen RCTs involving 5,859 participants were included. When compared with usual care, time in therapeutic range was higher in PSM/High/Pt and PST/High/e-Health with MD [95%CI] of 7.67% [0.26,15.08] and 5.65% [0.04,11.26], respectively. The proportion of international normalized ratio values in range in the usual care group and PSM/Low/Pt were lower than in other self-care features. The risk of thromboembolic events was lower in the PSM/Vary/Pt group when compared with PST/High/e-Health (RR 0.39 [0.20,0.77]) and usual care (RR 0.38 [0.17,0.88]). There was no significant difference in major bleeding and all-cause mortality among different self-care features. Conclusion: Patient self-care by measuring INR values at least once weekly or at the patient’s own convenience are more effective in controlling INR level.

High Soluble Thrombomodulin Is Associated with an Increased Risk of Major Bleeding during Treatment with Oral Anticoagulants: A Case–Cohort Study

2020 ◽  
Author(s):  
Myrthe M. A. Toorop ◽  
Nienke van Rein ◽  
Suzanne C. Cannegieter ◽  
Felix J. M. van der Meer ◽  
Pieter H. Reitsma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vitamin K ◽  
Major Bleeding ◽  
Cox Regression ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Soluble Thrombomodulin ◽  
Major Bleed ◽  
Increased Risk

Abstract Background Major bleeding occurs in 1 to 3% of patients treated with oral anticoagulants per year. Biomarkers may help to identify high-risk patients. A proposed marker for major bleeding while using anticoagulants is soluble thrombomodulin (sTM). Methods Plasma was available from 16,570 patients of the BLEEDS cohort that consisted of patients who started treatment with vitamin K antagonists between 2012 and 2014. A case–cohort study was performed including all patients with a major bleed (n = 326) during follow-up and a random sample of individuals selected at baseline (n = 652). Plasma sTM levels were measured and stratified by percentiles. Patients were also categorized by international normalized ratio (INR). Adjusted hazard ratios (for age, sex, hypertension, and diabetes) with 95% confidence intervals (CIs) were estimated by means of Cox regression. Results Plasma sTM levels were available for 263 patients with a major bleed and 538 control subjects. sTM levels were dose-dependently associated with risk of major bleeding, with a 1.9-fold increased risk (95% CI: 1.1–3.1) for levels above the 85th percentile versus the <25th percentile. A high INR (≥4) in the presence of high (≥70th percentile) sTM levels was associated with a 7.1-fold (95% CI: 4.1–12.3) increased risk of major bleeding, corresponding with a bleeding rate of 14.1 per 100 patient-years. Conclusion High sTM levels at the start of treatment are associated with major bleeding during vitamin K antagonist treatment, particularly in the presence of a high INR.

scholarly journals Comparative Effectiveness and Safety of 32 Pharmacological Interventions Recommended by Guidelines for COVID-19: A Systematic Review and Network Meta-Analysis Combining 66 Trials

2020 ◽  
Author(s):  
Shanshan Wu ◽  
Qingxin Zhou ◽  
Xueyang Zeng ◽  
Jingxue Zhang ◽  
Zhirong Yang ◽  
...  
Keyword(s):  
Standard Care ◽  
Meta Analysis ◽  
Antiviral Agents ◽  
Current Evidence ◽  
Cochrane Library ◽  
Cure Rate ◽  
Pharmacological Interventions ◽  
Assessment Development ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background: To evaluate comparative efficacy and safety of pharmacological interventions in patients with coronavirus disease 2019. Methods: Medline, Embase, the Cochrane Library and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with SARS-COV-2/SARS-COV. Random-effects network meta-analysis within Bayesian framework was performed, followed by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessing quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion (VNC) and overall adverse events (OAE). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.Results: 66 RCTs with 19,095 patients were included, involving standard care (SOC), 8 different antiviral agents, 6 different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids and other treatments. Compared with SOC, significant reduction of mortality was observed for TCM (OR=0.34, 95%CI: 0.20-0.56, moderate quality) and corticosteroids (OR=0.84, 0.75-0.96, low quality) with improved cure rate (OR=2.16, 1.60-2.91, low quality for TCM; OR=1.17, 1.05-1.30, low quality for corticosteroids). However, increased risk of mortality was found for CQ_HD versus SOC (OR=3.20, 1.18-8.73, low quality). TCM was associated with decreased risk of OAE (OR=0.52, 0.38-0.70, very low quality) but CQ_HD (OR=2.51, 1.20-5.24) and IFN (OR=2.69, 1.02-7.08) versus SOC with very low quality) were associated with an increased risk. Conclusions: Corticosteroids and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low quality and further high-quality trials are needed.

Sign in / Sign up

Export Citation Format

Share Document