Efficacy and safety of endovenous foam sclerotherapy: meta-analysis for treatment of venous disorders

2012 ◽  
Vol 27 (3) ◽  
pp. 105-117 ◽  
Author(s):  
S Rathbun ◽  
A Norris ◽  
J Stoner
Keyword(s):  
Meta Analysis ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
Safety And Efficacy ◽  
Related Data ◽  
Vein Occlusion ◽  
Electronic Search ◽  
The Usa ◽  
Similar Vein ◽  
Venous Disorders

Aim Endovenous foam sclerotherapy (EFS) is used widely throughout the USA for the treatment of venous disorders. The purpose of the quantitative meta-analysis was to systematically and comprehensively evaluate the literature to provide accurate estimates of safety and efficacy outcomes for this procedure. Methods A comprehensive electronic search of published literature in several databases was performed using a wide variety of MESH headings. In addition, meeting abstracts and bibliographies of selected references were reviewed for eligible papers. Two reviewers abstracted selected treatment-related data. Results Of 684 identified manuscripts and abstracts reviewed, 104 papers were abstracted and analysed. More than 50% were published between 2004 and 2008. EFS was found to be effective with similar vein occlusion rates to laser therapy, but less effective than surgery. In addition, major adverse effects were rare. Conclusions EFS is a safe and effective therapy for the treatment of venous disorders.

Performance of endovenous foam sclerotherapy in the USA for the treatment of venous disorders: ACP/SVM/AVF/SIR quality improvement guidelines

2013 ◽  
Vol 29 (2) ◽  
pp. 76-82 ◽  
Author(s):  
S Rathbun ◽  
A Norris ◽  
N Morrison ◽  
K Gibson ◽  
P Raymond-Martimbeau ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Varicose Veins ◽  
Meta Analysis ◽  
Previous Treatment ◽  
Signs And Symptoms ◽  
Primary Treatment ◽  
Consensus Panel ◽  
Foam Sclerotherapy ◽  
The Usa ◽  
Venous Disorders

Objective This report summarizes the findings of the consensus panel based on the results of the comprehensive questionnaire of US American College of Phlebology annual congress attendees and results of the systematic meta-analysis of the literature and provides quality improvement guidelines for the use of endovenous foam sclerotherapy (EFS) for the treatment of venous disorders, as well as identifies areas of needed research. Methods Based on the above data, quality improvement guidelines were developed and reviewed by the ten US consensus panel members and approved by their respective societies. Results EFS is effective for the treatment of truncal and tributary varicose veins, both as primary treatment and for treatment of recurrence. It may improve the signs and symptoms associated with varicose veins including pain and swelling. EFS is contraindicated in patients who have experienced an allergic reaction to previous treatment with foam or liquid sclerosant, and in patients with acute venous thrombosis events secondary to EFS. Conclusion These guidelines for the use of EFS in the treatment of venous disorders provide an initial framework for the safe and efficacious use of this therapy, and the impetus to promote the evaluation of the questions remaining regarding the use of EFS through well-designed randomized and cohort studies.

scholarly journals Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e032128
Author(s):  
Shuai Ming ◽  
Kunpeng Xie ◽  
Mingzhu Yang ◽  
Huijuan He ◽  
Ya Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Retinal Vein Occlusion ◽  
Real World ◽  
Meta Analysis ◽  
Real Life ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Intravitreal Dexamethasone

ObjectiveTo compare the efficacy and safety of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of macular oedema secondary to retinal vein occlusion (RVO).DesignSystematic review and meta-analysis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE).Data sourcesPubMed, Cochrane Library and ClinicalTrials.gov registry were searched from inception to 10 December 2019, without language restrictions.Eligibility criteriaRandomised controlled trials (RCTs) and real-world observation studies comparing the efficacy of DEX implant and anti-VEGF agents for the treatment of patients with RVO, naïve or almost naïve to both arms, were included.Data extraction and synthesisTwo reviewers independently extracted data for mean changes in best-corrected visual acuity (BCVA), central subfield thickness (CST) and product safety. Review Manager V.5.3 and GRADE were used to synthesise the data and validate the evidence, respectively.ResultsFour RCTs and 12 real-world studies were included. An average lower letter gain in BCVA was determined for the DEX implant (mean difference (MD) = −6.59; 95% CI −8.87 to −4.22 letters) administered at a retreatment interval of 5–6 months. Results were similar (MD6 months=−12.68; 95% CI −21.98 to −3.37 letters; MD12 months=−9.69; 95% CI −12.01 to −7.37 letters) at 6 and 12 months. The DEX implant resulted in comparable or marginally less CST reduction at months 6 and 12 but introduced relatively higher risks of elevated intraocular pressure (RR=3.89; 95% CI 2.16 to 7.03) and cataract induction (RR=5.22; 95% CI 1.67 to 16.29). Most real-life studies reported an insignificant numerical gain in letters for anti-VEGF drugs relative to that for DEX implant. However, the latter achieved comparable efficacy with a 4-month dosage interval.ConclusionCompared with anti-VEGF agents, DEX implant required fewer injections but had inferior functional efficacy and safety. Real-life trials supplemented the efficacy data for DEX implant.

scholarly journals Safety and Efficacy of Low Molecular Weight Heparin for Thromboprophylaxis in the Elderly: A Network Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Hui-qin Yang ◽  
Man-cang Liu ◽  
Wen-jun Yin ◽  
Ling-yun Zhou ◽  
Xiao-cong Zuo
Keyword(s):  
Molecular Weight ◽  
High Risk ◽  
Low Molecular Weight Heparin ◽  
Meta Analysis ◽  
The Elderly ◽  
Cumulative Probability ◽  
Low Molecular Weight ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Safety Outcomes

Background: Given their changing pathophysiology, elderly patients carry a high risk of embolism and bleeding events; hence, use of appropriate anticoagulants is very important. Low molecular weight heparin (LMWH) is one of the most widely used anticoagulants although LMWHs differ in their anti-Xa, antithrombin, and anticoagulant activities. To date, no study has directly compared the safety and efficacy of different LMWHs in the elderly. We aimed to compare such differences by conducting a network meta-analysis.Methods: We searched the Pubmed, Embase, and Cochrane databases for randomized controlled trials (RCTs) of LMWHs that included patients ≥60 years old up to July 22, 2020. Safety outcomes included venous thromboembolism (VTE) or VTE-related death, deep thrombus embolism, and pulmonary embolism. Safety outcomes were clinically relevant bleeding, major bleeding, minor bleeding, and all-cause death. We calculated relative ratios (RR) and 95% confidence intervals (CI) for all outcomes. The cumulative ranking probabilities (SUCRA) were conducted to rank the comparative effects and safety of all LMWHs.Results: We included 27 RCTs (30,441 elderly), comprising five LMWHs. LMWH was more effective than placebo in preventing VTE or VTE-related death (RR 0.36, 95% CI 0.25–0.53) but less effective than a novel oral anticoagulant (RR 1.59, 95% CI 1.33–1.91) and safer than acenocoumarol regarding risk of clinically relevant bleeding (RR 0.67, 95% CI 0.49–0.90). However, indirect comparison of efficacy and safety of the five LMWHs showed no significant difference in our network analysis, and the subgroup analyses (such as in patients with deep venous thrombosis, cardiac disease, or age >65 years old) supported the results. The SUCRA showed that tinzaparin performed best in preventing VTE or VTE-related death (SUCRA 68.8%, cumulative probability 42.3%) and all-cause death (SUCRA 84.2%, cumulative probability 40.7%), whereas nadroparin was predominant in decreasing the risk of clinically relevant bleeding (SUCRA 84.8%, cumulative probability 77.0%).Conclusions: On present evidence, there are no significant differences in the efficacy and safety of different LMWHs for the elderly. According to the rank probability analysis, nadroparin seems to be safer for the elderly with a high risk of bleeding, whereas tinzaparin is more effective for those with low bleeding risk.

Técnica de fios de polidioxanona no terço inferior da face - relato de caso

2021 ◽  
Vol 2 (6) ◽  
pp. 36-42
Author(s):  
Kananda Desbesel de Carvalho ◽  
Beatriz Rodrigues Póvoa
Keyword(s):  
Case Report ◽  
Clinical Case ◽  
Invasive Technique ◽  
Physiological Effects ◽  
Medium Term ◽  
Safety And Efficacy ◽  
Electronic Search ◽  
The Face ◽  
The Usa ◽  
The Aesthetic

Wired facial lifting is a minimally invasive technique that allows for a quick lifting effect. The aim of this study is to address the effectiveness of spiked Polydioxanone (PDO) threads (cog) for facial rejuvenation of the lower third of the face, through a clinical case report. The methodology was characterized by a brief bibliographic review, through an electronic search in the databases: Pubmed, Lilacs, Cochrane and bibliographic bases published in the USA and Brazil, associated with a clinical case report, making it possible to compare it with data from the literature on complications, safety and efficacy in the short and medium term. It is concluded that the aesthetic treatments seek to soften the signs of time and rescue the elasticity and firmness of the dermis. For this, it is necessary to elucidate the physiological effects, providing opportunities for safe treatment.

scholarly journals T28. BENEFITS AND HARMS OF ANTIPSYCHOTICS IN THE TREATMENT OF CHILDREN AND ADOLESCENTS WITH SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S242-S242
Author(s):  
Katsuhiko Hagi ◽  
Tadashi Nosaka ◽  
Andrei Pikalov
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Two Dimensional ◽  
Primary Efficacy ◽  
Efficacy And Safety ◽  
Electronic Search ◽  
Clinical Benefits ◽  
Dimensional Graph

Abstract Background Childhood and adolescent schizophrenia is a severe and debilitating disorder associated with long-term impairments in functioning, poor physical health, and reduced life expectancy. Compared with adult-onset schizophrenia, childhood and adolescent schizophrenia may be a more severe disorder, negatively influencing social, cognitive and psychological development, educational achievements and life-long occupational functioning. Therefore, treatment of childhood and adolescent schizophrenia is highly important and presents a major therapeutic challenge. The aim of this systematic review and meta-analysis was to assess whether antipsychotics (APs) have different clinical benefits and harms profiles in acute treatment of childhood and adolescent schizophrenia. Methods We conducted systematic review and meta-analysis of randomized placebo-controlled trials (RCTs) assessing efficacy and adverse effects of APs in acute childhood and adolescent schizophrenia to compare clinical benefits and harms. An electronic search was conducted without language restrictions using Embase, Scopus, MEDLINE/PubMed, the Cochrane library, and the US National Institutes of Health clinical trials registry (http://www.clinicaltrials.gov). The electronic search was supplemented by a hand search of reference lists of relevant studies and reviews. The primary efficacy outcome examined was treatment response. The primary safety/tolerability was assessed based on discontinuation due to adverse event. In order to visualize the risk and benefit tradeoff of each AP, risk ratios (RRs) were plotted on two-dimensional graph for the primary efficacy and safety/tolerability outcomes. Results Ten studies were selected, comprising of 2,271 patients across eight active interventions (aripiprazole, asenapine, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone) and placebo. The mean intervention duration was 6.4 weeks (range 6–8 weeks). Lurasidone, asenapine and risperidone had significantly higher response rate (RR = 1.54, 95% CI = 1.21 to 1.95, p<0.001; RR = 1.38, 95% CI = 1.02 to 1.85, p=0.035; and RR = 1.71, 95% CI = 1.39 to 2.11, p<0.001, respectively) compared with placebo. These three antipsychotics also had significant single digit numbers needed to treat (NNT = 5, 4, and 8, respectively). All APs did not significantly separate from placebo in discontinuation rate due to adverse event compared with placebo (RR = 0.47 to 5.42). Aripiprazole had the significant number needed to harm (NNH = 25). On a two-dimensional graph plot of efficacy and safety/tolerability, lurasidone showed the most desirable profile for the risk / benefit tradeoff balance among all antipsychotics. Discussion Results from this meta-analysis illustrate that there are significant differences in benefits and harms among APs in the treatment of childhood and adolescent schizophrenia. Medications choice needs to be carefully evaluated to achieve optimal clinical benefit while minimizing burden of side effects for the patients.

scholarly journals Safety and Efficacy of Vitamin K Antagonists vs. Novel Oral Anticoagulants in Patients With Left Ventricular Thrombus: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
He Xuan ◽  
Yi-Ming Chen ◽  
Yun-Lang Dai ◽  
Jing Zhou ◽  
Yu-Feng Jiang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Left Ventricular ◽  
Sensitivity Analyses ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Ventricular Thrombus ◽  
Clinically Significant

Aims: A meta-analysis was conducted to evaluate the safety and efficacy of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in patients with left ventricular thrombus (LVT).Methods and Results: We searched PubMed, Web of Science, and Cochrane Library for cohort studies comparing the use of VKAs vs. NOACs for the treatment of LVT from the earliest date available to September 30, 2020. The predetermined efficacy and safety outcomes included thromboembolic events, resolution of LVT, clinically significant bleedings, and all-cause death. Fixed-effects model was used to estimate the pooled effects. Publication bias analyses and sensitivity analyses were conducted to check the robustness of results. A total of 6 studies enrolling 837 patients (mean age 60.2 ± 1.6 years; 77.2% were male) were included. We found no significant differences in thromboembolic events [relative risk (RR) 1.69, 95% confidence interval (CI) 0.94–3.06, P 0.08, I2 12.7%], the rate of resolution of thrombus (RR 1.08, 95% CI 0.96–1.21, P 0.21, I2 4.8%), and clinically significant bleedings (RR 0.70, 95% CI 0.37–1.32, P 0.27, I2 0%) between the VKAs and NOACs group. Additionally, no significant difference in all-cause mortality was found between the two groups (RR 1.24, 95% CI 0.79–1.96, P 0.35, I2 0.0%). Sensitivity analyses, using the “1-study removed” method, detected no significant differences.Conclusion: NOACs and VKAs have similar efficacy and safety in treating LVT, prompting the inference that NOACs are the possible alternatives of VKAs in LVT therapy.

Efficacy and Safety of Electroconvulsive Therapy in Depressive Disorders

2018 ◽  
Author(s):  
Joseph J. Taylor ◽  
Robert Ostroff
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Clinical Case ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Life Saving ◽  
Basic Concepts

This chapter will summarize an important systematic review and meta-analysis. The authors of this study analyzed decades of evidence from thousands of patients in order to address fundamental questions about the safety and efficacy of electroconvulsive therapy for depressive symptoms. The data from this manuscript continue to inform clinical practice in regards to this stigmatized yet potentially life-saving treatment. The chapter will discuss the setup and implementation of the systematic review and meta-analysis before focusing on the results and their implications. The last section of the chapter will identify relevant studies and present a hypothetical clinical case that requires the reader to apply basic concepts learned from the systematic review and meta-analysis.

scholarly journals Laparoscopic Versus Conventional Open Treatment of Liver Hydatid: A Systematic Review and Meta-analysis of Cohort Studies

2022 ◽  
Author(s):  
Zheng Wang ◽  
◽  
Hai-Hong Zhu ◽  
Jin-Yu Yang ◽  
Yan Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Safety And Efficacy ◽  
Advantages And Disadvantages ◽  
Open Treatment ◽  
Review Question ◽  
Hepatic Echinococcosis

Review question / Objective: With the popularity of laparoscopy and minimally invasive technology, laparoscopy has been applied to hepatic echinococcosis. However, the safety and efficacy of traditional laparotomy and laparoscopy are unclear. This study aimed to explore the advantages and disadvantages of laparoscopy and traditional laparotomy with a Meta-analysis.To compare the efficacy and safety of laparoscopic with that of traditional laparotomy. Condition being studied: There still exist controversies about the advantages and disadvantages of laparoscopic and traditional open surgery.

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