scholarly journals Combined 5-Fluorouracil and Low Molecular Weight Heparin for the Prevention of Postoperative Proliferative Vitreoretinopathy in Patients With Retinal Detachment: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Chen Chen ◽  
Peng Chen ◽  
Xia Liu ◽  
Hua Li
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Low Molecular Weight Heparin ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Low Molecular Weight ◽  
Number Of Patients ◽  
Primary Success

Background: Postoperative proliferative vitreoretinopathy (PVR) remains a dilemma for retinal surgeons. We performed a literature search and meta-analyses to figure out whether combined 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) treatment were effective in improving the primary success of vitrectomy and preventing postoperative PVR occurrence in patients with retinal detachment (RD).Methods: Databases including PubMed, Embase, the Cochrane library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 2021. Comparative studies approaching the effects of combined 5-FU and LMWH on postoperative PVR were included. Quality assessment was performed using RoB 2 and ROBINS-I tool. Study data were pooled using Review manager 5.4.1. The main outcomes were: the primary success of vitrectomy at 6 months and the postoperative PVR occurrence. The additional outcomes were: number of patients who underwent vitreoretinal reoperations and the number of vitreoretinal reoperations due to postoperative PVR. Subgroup analyses and sensitivity analyses were also performed.Results: Six clinical trials with a total of 1,208 participants were included. We found that combined 5-FU and LMWH infusion did not improve the primary success of vitrectomy at 6 months (RR = 1.00, 95% CI = 0.95, 1.07, P = 0.89, I2 = 50%). Also, the conjunct therapy had no effect on reducing the number of patients who underwent vitreoretinal reoperations (RR = 1.00, 95% CI = 0.78, 1.28, P = 1.00, I2 = 42%). The overall effect of the treatment on preventing postoperative PVR was negative. However, in patients with PVR grade C (PVRC) before intervention, the 5-FU and LMWH treatment significantly reduced PVR occurrence. Visual acuity was not different between the treatment and control groups. Nevertheless, in one RCT, a significant reduction of VA was observed in the treatment group in macular-sparing patients with RD. No complications were attributed to the conjunct therapy.Conclusions: The combined 5-FU and LMWH treatment neither improved the primary success of vitrectomy at 6 months nor decreased number of patients who underwent vitreoretinal reoperations. Thus, the treatment should not be routinely used in vitrectomy for patients with RD. However, the treatment proved beneficial in reducing postoperative PVR in patients with PVRC before intervention. More high-quality clinical trials are needed to confirm the results.Systematic Review Registration:https://inplasy.com/inplasy-2021-8-0117/, identifier: INPLASY202180117.

scholarly journals Anticoagulation in acute ischemic stroke: A systematic search

2017 ◽  
Vol 63 (1) ◽  
pp. 50-56
Author(s):  
Nayara L. Froio ◽  
◽  
Richard Murdoch Montgomery ◽  
Elias David-Neto ◽  
Ivan Aprahamian
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Low Molecular Weight Heparin ◽  
Cochrane Library ◽  
Low Molecular Weight ◽  
Large Artery ◽  
Stroke Etiology ◽  
Clinical Scenarios ◽  
The Ideal

Summary Introduction: Stroke is one of the most important diseases worldwide. Several clinical scenarios demand full dose of anticoagulants primary to stroke etiology or to the treatment of comorbidity. However, controversy exists over many issues regarding anticoagulation treatment in stroke such as time for initiation, efficacy according to stroke etiology, the ideal dose of anticoagulants, and whether novel anticoagulants should be used. Method: Computerized search for clinical trials and randomized controlled clinical trials was done to the present date at Medline, Scielo, Embase, PsychInfo, and Cochrane Library using MeSH terms and the keywords stroke, ischemic stroke, anticoagulation, anticoagulants, heparin, low-molecular-weight heparin, warfarin, dabigatran, rivaroxaban, apixaban. The PRISMA statement was used to evaluate clinical trials. Results: Fourteen clinical trials were selected based on inclusion criteria. No evidence was found supporting the early use of heparin, heparinoids or low-molecular-weight heparin (LMWH) early after stroke. No consistent evidence for the use of warfarin and the newer oral anticoagulants were found. Argatroban was the only anticoagulant with significant positive results early after large-artery ischemic stroke. Conclusion: The ideal time for initiating anticoagulation remains undefined, requiring further investigation. Early anticoagulation for ischemic stroke is not recommended, with few exceptions, such as that of argatroban.

scholarly journals Combined 5-Fluorouracil and Low Molecular Weight Heparin for the Prevention of Postoperative Proliferative Vitreoretinopathy in Patients with Retinal Detachment

2021 ◽  
Author(s):  
Chen Chen ◽  
◽  
Peng Chen ◽  
Xia Liu ◽  
Hua Li
Keyword(s):  
Molecular Weight ◽  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Low Molecular Weight Heparin ◽  
Meta Analysis ◽  
Retinal Pigment ◽  
Retinal Pigment Epithelial Cells ◽  
Low Molecular Weight ◽  
Collagen Contraction ◽  
And Migration

Review question / Objective: The aim of this meta-analysis is to evaluate the efficacy and safety of intraoperative infusion of combined 5-fluorouracil and low molecular weight heparin (LMWH) for the prevention of postoperative proliferative vitreoretinopathy in patients with retinal detachment. Condition being studied: Postoperative proliferative vitreoretinopathy (PVR) is the primary cause of failure of retinal reattachment surgery. 5-fluorouracil (5-FU) inhibits the proliferation of fibroblasts, and suppresses collagen contraction. On the other hand, heparin reduces fibrin exudation, and inhibits the adhesion and migration of retinal pigment epithelial cells. We conduct this comprehensive literature search and meta-analysis to address whether intraoperative infusion of combined 5-FU and LWMH improves the primary success rate of pars plana vitrectomy, as well as reduces postoperative PVR. Our study aims to provide clinical evidence for retinal surgeons concerning their choice of intraoperative medication.

The Relationship between Use of Low Molecular Weight Heparin during Pregnancy and Risk of Peripartum Adverse Events: A Meta-Analysis

2021 ◽  
Vol 8 (11) ◽  
Author(s):  
Xiaorong Y ◽  
◽  
Shan L ◽  
Shengji S ◽  
Tao S ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Adverse Events ◽  
Pregnant Women ◽  
Low Molecular Weight Heparin ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Premature Delivery ◽  
Low Molecular Weight ◽  
Significant Difference ◽  
Fetal Complications

Introduction: To summarize the trials investigated on relationship between low molecular weight heparin use during pregnancy and peripartum adverse events. Meta-analysis was performed to evaluate the effect of Low Molecular Weight Heparin (LMWH) on maternal and fetal complications. Methods: Electronic research was performed in Cochrane Library, MEDLINE and EMBASE through October 2020. The primary outcome was the incidence of maternal and fetal complications during peripartum period. RevMan 5.3 was used for data analysis. Results: 11 articles were finally included. Meta-analysis showed there was no significant difference in abortion, premature delivery, stillbirth, preeclampsia and postpartum hemorrhage events between pregnant women who used LMWH and those who not. Conclusion: Using LMWH in pregnant women does not increase pregnancy related maternal and fetal complications.

Low molecular weight heparin and cancer survival: clinical trials and experimental mechanisms

2016 ◽  
Vol 142 (8) ◽  
pp. 1807-1816 ◽  
Author(s):  
Ning Zhang ◽  
Weihua Lou ◽  
Fang Ji ◽  
Lihua Qiu ◽  
Benjamin K. Tsang ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Low Molecular Weight Heparin ◽  
Cancer Survival ◽  
Low Molecular Weight

Use of a Low-Molecular Weight Heparin (Enoxaparin) or of a Phenformin-like Substance (Moroxydine Chloride) in Primary Early Recurrent Aborters with an Impaired Fibrinolytic Capacity

1995 ◽  
Vol 73 (03) ◽  
pp. 362-367 ◽  
Author(s):  
Jean-Christophe Gris ◽  
Sylvie Neveu ◽  
Marie-Laure Tailland ◽  
Christophe Courtieu ◽  
Pierre Marès ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Venous Occlusion ◽  
Clot Lysis ◽  
Primary Study ◽  
Low Molecular Weight ◽  
Occlusion Test ◽  
Number Of Patients ◽  
Fibrinolytic Capacity ◽  
Venous Occlusion Test

SummaryAn impaired fibrinolytic capacity, defined as an insufficient venous occlusion-induced shortening of the plasma euglobulin clot lysis time, is a common feature in women suffering from primary early recurrent unexplained miscarriages (1,2). We investigated the therapeutic effect of a low-molecular-weight heparin and of a phenformin-like substance.In a prospective, randomized trial, 30 consecutive patients initially received either enoxaparin, 20 mg per day during one month, or moroxydine chloride, 1200 mg per day during one month. In case of fibrinolytic status normalization, they were treated during 6 months by the beneficial treatment which was planned to be continued during eventual pregnancies. Patients with hypofibrinolysis persistence received the alternative treatment during another month and a new evaluation was performed. No treatment was given when a persistent abnormal response to the venous occlusion test was evidenced. In case of positive response, the treatment was continued during 6 months. The primary study end-points consisted of any of the following: effect of the treatments on the fibrinolytic response; number of patients becoming pregnant during the 6 months following the last venous occlusion test; number of full-term pregnancies.Concerning the effects on the fibrinolytic system, 20 out of 29 women responded to the first or second-line enoxaparin treatment whereas only 1 woman out of 19 responded to moroxydine chloride (p=0.00002). Concerning the effects on fertility, responders to LMWH were more likely to initiate a new pregnancy than non-responders (16/20 vs 2/10, p=0.002). In patients conceiving, LMWH responders were more likely to obtain live births than nonresponders (13/16 vs. 0/2, p=0.02). The 9 women who had not responded to both treatments and the one who had responded to moroxydine chloride are still childless. Thirteen of the 20 previously childless women who had responded to enoxaparin had a successful pregnancy whilst taking the low-molecular weight heparin (p=0.0009).The low-molecular weight heparin enoxaparin was associated with successful pregnancies in patients with recurrent unexplained miscarriages associated with an impaired fibrinolytic capacity.

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