scholarly journals Geographical Variance in the Use of Tranexamic Acid for Major Trauma Patients

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 561
Author(s):  
Walsh ◽  
O’Keeffe ◽  
Mitra
Keyword(s):  
Tranexamic Acid ◽  
Meta Analysis ◽  
Geographical Location ◽  
Significant Risk ◽  
Geographic Region ◽  
Randomised Control Trial ◽  
Trauma Patients ◽  
Randomised Control Trials ◽  
Newcastle Ottawa Scale ◽  
Injured Patients

Background and Objectives: The CRASH-2 trial is the largest randomised control trial examining tranexamic acid (TXA) for injured patients. Since its publication, debate has arisen around whether results could be applied to mature trauma systems in developed nations, with global opinion divided. The aim of this study was to determine if, among trauma patients in or at significant risk of major haemorrhages, there is an association of geographic region with the proportion of patients that received tranexamic acid. Materials and Methods: We conducted a systematic review of the literature. Potentially eligible papers were first screened via title and abstract screening. A full copy of the remaining papers was then obtained and screened for final inclusion. The Newcastle–Ottawa Scale for non-randomised control trials was used for quality assessment of the final studies included. A meta-analysis was conducted using a random-effects model, reporting variation in use sub-grouped by geographical location. Results: There were 727 papers identified through database searching and 23 manuscripts met the criteria for final inclusion in this review. There was a statistically significant variation in the use of TXA for included patients. Europe and Oceania had higher usage rates of TXA compared to other continents. Use of TXA in Asia and Africa was significantly less than other continents and varied use was observed in North America. Conclusions: A large geographical variance in the use of TXA for trauma patients in or at significant risk of major haemorrhage currently exists. The populations in Asia and Africa, where the results of CRASH-2 could be most readily generalised to, reported low rates of use. The reason why remains unclear and further research is required to standardise the use of TXA for trauma resuscitation.

scholarly journals Efficacy and safety of the second in-hospital dose of tranexamic acid after receiving the prehospital dose: double-blind randomized controlled clinical trial in a level 1 trauma center

2021 ◽  
Author(s):  
Ayman El-Menyar ◽  
Khalid Ahmed ◽  
Suhail Hakim ◽  
Ahad Kanbar ◽  
Saji Mathradikkal ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Tranexamic Acid ◽  
Blood Transfusions ◽  
Trauma Patients ◽  
Thromboembolic Events ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Hospital Arrival ◽  
Late Mortality ◽  
Injured Patients

Abstract Background Prehospital administration of tranexamic acid (TXA) to injured patients is increasing worldwide. However, optimal TXA dose and need of a second infusion on hospital arrival remain undetermined. We investigated the efficacy and safety of the second in-hospital dose of TXA in injured patients receiving 1 g of TXA in the prehospital setting. We hypothesized that a second in-hospital dose of TXA improves survival of trauma patients. Methods A prospective, double-blind, placebo-controlled randomized, clinical trial included adult trauma patients receiving 1 g of TXA in the prehospital settings. Patients were then blindly randomized to Group I (second 1-g TXA) and Group II (placebo) on hospital arrival. The primary outcome was 24-h (early) and 28-day (late) mortality. Secondary outcomes were thromboembolic events, blood transfusions, hospital length of stay (HLOS) and organs failure (MOF). Results A total of 220 patients were enrolled, 110 in each group. The TXA and placebo groups had a similar early [OR 1.000 (0.062–16.192); p = 0.47] and late mortality [OR 0.476 (95% CI 0.157–1.442), p = 0.18].The cause of death (n = 15) was traumatic brain injury (TBI) in 12 patients and MOF in 3 patients. The need for blood transfusions in the first 24 h, number of transfused blood units, HLOS, thromboembolic events and multiorgan failure were comparable in the TXA and placebo groups. In seriously injured patients (injury severity score > 24), the MTP activation was higher in the placebo group (31.3% vs 11.10%, p = 0.13), whereas pulmonary embolism (6.9% vs 2.9%, p = 0.44) and late mortality (27.6% vs 14.3%, p = 0.17) were higher in the TXA group but did not reach statistical significance. Conclusion The second TXA dose did not change the mortality rate, need for blood transfusion, thromboembolic complications, organ failure and HLOS compared to a single prehospital dose and thus its routine administration should be revisited in larger and multicenter studies. Trial registration ClinicalTrials.gov Identifier: NCT03846973.

scholarly journals A Systematic Review and Meta-Analysis of the Incidence Rate of Takayasu Arteritis

2020 ◽  
Author(s):  
Megan Rutter ◽  
Jonathan Bowley ◽  
Peter C. Lanyon ◽  
Matthew J. Grainge ◽  
Fiona A. Pearce
Keyword(s):  
Incidence Rate ◽  
Takayasu Arteritis ◽  
Meta Analysis ◽  
Geographical Location ◽  
Incidence Rates ◽  
Future Research ◽  
Autoimmune Rheumatic Disease ◽  
Global Epidemiology ◽  
Newcastle Ottawa Scale ◽  
Different Populations

AbstractObjectivesTakayasu arteritis (TAK), is a rare autoimmune rheumatic disease causing large vessel vasculitis. Onset is typically between the ages of 20-30. It is associated with substantial morbidity and mortality, notably due to its effects on the cardiovascular system. It has a poorly understood global epidemiology. Our objective was to systematically review the available evidence in order to calculate the incidence rate of TAK.MethodsThree databases (Medline, PubMed and Embase) were searched in November 2019 and the results were screened by two reviewers. A random effects meta-analysis was then conducted in R to calculate the overall incidence rate. Heterogeneity was assessed using I2. The quality of the studies was assessed using an adapted Newcastle-Ottawa scale. Further sub-group analyses were performed by quality, sex, research setting and geographical location. Publication bias was assessed using a Begg’s funnel plot.ResultsThe incidence rate for TAK per million person-years with 95% confidence intervals was 1.11 per million person years (95% CI 0.75 – 1.65). The heterogeneity in the data was extremely high in all analyses, which suggests that there was considerable variation in incidence rates across the different populations studied. TAK was found to be more common in women (incidence rate 2.01 per million person-years, 95% CI 1.39-2.90).ConclusionsTAK is an extremely rare disease. It affects women more commonly than men. There is considerable variation in the incidence rate between populations. We suggest that future research should focus on discrete populations in order to better identify genetic and environmental risk factors.

Influence of Epidemiologic and Patient Behavior–Related Predictors on Amputation Rates in Diabetic Patients

2017 ◽  
Vol 16 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Jin Yong Shin ◽  
Si-Gyun Roh ◽  
Nae-Ho Lee ◽  
Kyung-Moo Yang
Keyword(s):  
Risk Factors ◽  
Diabetic Foot ◽  
Meta Analysis ◽  
Significant Risk ◽  
Amputation Rate ◽  
Diabetic Patients ◽  
Patient Behavior ◽  
Randomized Controlled Studies ◽  
Newcastle Ottawa Scale

Amputation of patients with diabetic foot is a major issue worldwide, particularly from a medical and economic standpoint. This meta-analysis aimed to identify significant risk factors of high amputation rate among epidemiologic and patient behavior–related predictors in diabetic patients. A systematic literature review and meta-analysis were performed using MEDLINE, EMBASE, and Cochrane databases. Seven variables were extracted from the included studies and evaluated based on amputation rate. The Newcastle-Ottawa scale was used to assess the quality of the studies. The search strategy identified 101 publications. After screening, 33 articles were selected for review. Male sex and smoking were identified as significant risk factors of high amputation rate of diabetic foot. Although further investigation of long-term and randomized controlled studies is needed, we identified 2 variables as significant risk factors for high amputation rate in diabetic patients in this meta-analysis.

scholarly journals Estimating the prevalence of heterozygous familial hypercholesterolaemia: a systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016461 ◽  
Author(s):  
Leo E Akioyamen ◽  
Jacques Genest ◽  
Shubham D Shan ◽  
Rachel L Reel ◽  
Jordan M Albaum ◽  
...  
Keyword(s):  
Systematic Review ◽  
Familial Hypercholesterolaemia ◽  
Meta Analysis ◽  
Geographical Location ◽  
Significant Risk ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Cvd Risk ◽  
Premature Cardiovascular Disease ◽  
Heterozygous Familial Hypercholesterolaemia

ObjectivesHeterozygous familial hypercholesterolaemia (FH) confers a significant risk for premature cardiovascular disease (CVD). However, the estimated prevalence of FH varies substantially among studies. We aimed to provide a summary estimate of FH prevalence in the general population and assess variations in frequency across different sociodemographic characteristics.Setting, participants and outcome measuresWe searched MEDLINE, EMBASE, Global Health, the Cochrane Library, PsycINFO and PubMed for peer-reviewed literature using validated strategies. Results were limited to studies published in English between January 1990 and January 2017. Studies were eligible if they determined FH prevalence using clinical criteria or DNA-based analyses. We determined a pooled point prevalence of FH in adults and children and assessed the variation of the pooled frequency by age, sex, geographical location, diagnostic method, study quality and year of publication. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were investigated through subgroups, meta-regression and sensitivity analyses.ResultsThe pooled prevalence of FH from 19 studies including 2 458 456 unique individuals was 0.40% (95% CI 0.29% to 0.52%) which corresponds to a frequency of 1 in 250 individuals. FH prevalence was found to vary by age and geographical location but not by any other covariates. Results were consistent in sensitivity analyses.ConclusionsOur systematic review suggests that FH is a common disorder, affecting 1 in 250 individuals. These findings underscore the need for early detection and management to decrease CVD risk.

scholarly journals Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis

2020 ◽  
Vol 29 (156) ◽  
pp. 190166 ◽  
Author(s):  
Jaber S. Alqahtani ◽  
Chidiamara M. Njoku ◽  
Bonnie Bereznicki ◽  
Barbara C. Wimmer ◽  
Gregory M. Peterson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factor ◽  
Meta Analysis ◽  
Significant Risk ◽  
Contributing Factors ◽  
Copd Exacerbations ◽  
Increased Risk ◽  
Newcastle Ottawa Scale ◽  
Exacerbation Of Copd ◽  
Meta Analyses

BackgroundReadmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD.MethodsWe systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle–Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model.ResultsIn total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8–26.0% at 30 days and from 17.5–39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22–1.37)), renal failure (1.26 (1.19–1.33)), depression (1.19 (1.05–1.34)) and alcohol use (1.11 (1.07–1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88–0.94)).ConclusionsComorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.

scholarly journals Does Liberal Prehospital and In-Hospital Tranexamic Acid Influence Outcome in Severely Injured Patients? A Prospective Cohort Study

2021 ◽  
Author(s):  
Karlijn J. P. van Wessem ◽  
Luke P. H. Leenen
Keyword(s):  
Cohort Study ◽  
Tranexamic Acid ◽  
Hemorrhagic Shock ◽  
Prospective Cohort Study ◽  
Complication Rate ◽  
Prospective Cohort ◽  
Morbidity And Mortality ◽  
Trauma Patients ◽  
Severely Injured ◽  
Injured Patients

Abstract Background Early hemorrhage control is important in trauma-related death prevention. Tranexamic acid (TXA) has shown to be beneficial in patients in hemorrhagic shock, although widespread adoption might result in incorrect TXA administration leading to increased morbidity and mortality. Methods A 7-year prospective cohort study with consecutive trauma patients admitted to a Level-1 Trauma Center ICU was performed to investigate administration of both pre- and in-hospital TXA and its relation to morbidity and mortality. Indication for prehospital and in-hospital TXA administration was (suspicion of) hemorrhagic shock, and/or systolic blood pressure (SBP) ≤ 90 mmHg. Demographics, data on physiology, resuscitation and outcomes were prospectively collected. Results Four hundred and twenty-two patients (71% males, median ISS 29, 95% blunt injuries) were included. Even though TXA patients were more severely injured with more deranged physiology, no differences in outcome were noted. Overall, thrombo-embolic complication rate was 8%. In half the patients, hemorrhagic shock was the indication for prehospital TXA, whereas 79% of in-hospital TXA was given based on suspicion of hemorrhagic shock. Thirteen percent of patients with SBP ≤ 90 mmHg in ED received no TXA at all. Based on SBP alone, 22% of prehospital TXA and 25% of in-hospital TXA were justified. Conclusions Despite being more severely injured, TXA patients had similar outcome compared to patients without TXA. Thrombo-embolic complication rate was low despite liberal use of both prehospital and in-hospital TXA. Caution should be exercised in selecting patients for TXA, although this might be challenging based on SBP alone in patients who do not yet show signs of deranged physiology on arrival in ED.

Maternal Risk Factors for Lactation Mastitis: A Meta-analysis

2020 ◽  
pp. 019394592096767
Author(s):  
Yuan Deng ◽  
Yan Huang ◽  
Ping Ning ◽  
Se-Ge Ma ◽  
Pei-Yu He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Meta Analysis ◽  
Significant Risk ◽  
Risk Identification ◽  
Cochrane Library ◽  
Maternal Risk Factors ◽  
Case Control Studies ◽  
Maternal Risk ◽  
Newcastle Ottawa Scale ◽  
Lactational Mastitis

This meta-analysis was conducted to identify maternal risk factors for lactational mastitis. Studies published in English or Chinese were retrieved from Medline (PubMed), Embase, Cochrane Library, Web of Science, CNKI, WANFANG, and VIP databases according to predefined inclusion and exclusion criteria. Study quality was assessed by the Newcastle–Ottawa Scale. A random-effects model was used for data pooling and I2 tests to assess study heterogeneity. Pooled data from 8 cohorts and 10 case–control studies identified previous mastitis during breastfeeding (P<0.00001), cesarean section (P=0.001), breast trauma (P<0.001), anemia (P=0.0001), latch problems ≤ 8 weeks post-delivery (P=0.003), milk overproduction (P=0.002), blocked duct (P<0.0001), cracked nipple (especially ≤ 4 weeks post-delivery) (P=0.0001), use of nipple shields (P<0.00001), nipple cream (P<0.0001), brassieres (P<0.0001), and breast pumps (P<0.00001), and breastfeed duration > 30 min (P=0.008) as significant risk factors. Washing nipples before breastfeeding decreased lactational mastitis risk. Identification of these risk factors may facilitate the development of nursing care protocols for reducing lactational mastitis.

scholarly journals Clinical Characteristics of 2019 Novel Infected Coronavirus Pneumonia: A Systemic Review and Meta-analysis

2020 ◽  
Author(s):  
Kai Qian ◽  
Yi Deng ◽  
Yong-Hang Tai ◽  
Jun Peng ◽  
Hao Peng ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Meta Analysis ◽  
Ground Glass Opacity ◽  
Geographic Region ◽  
Ct Imaging ◽  
Systemic Review ◽  
Cochrane Library ◽  
Medicine Research ◽  
Newcastle Ottawa Scale ◽  
Assess Quality

ABSTRACTBackgroundA novel pneumonia associated with the 2019 coronavirus infected pneumonia (NCIP) suddenly broke out in Wuhan, China in December 2019. 37287 confirmed cases and 813 death case in China (Until 8th/Feb/2019) have been reported in just fortnight. Although this risky pneumonia with high infection rates and high mortality rates need to be resolved immediately, major gaps in our knowledge of clinical characters of it were still not be established. The aim of this study is to summaries and analysis the clinical characteristics of 2019-nCoV pneumonia.MethodsLiteratures have been systematically performed a search on PubMed, Embase, Web of Science, GreyNet International, and The Cochrane Library from inception up to February 8, 2020. The Newcastle-Ottawa Scale was used to assess quality, and publication bias was analyzed by Egger’s test. In the single-arm meta-analysis, A fix-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region and research scale.ResultsA total of nine studies including 356 patients were included in this study, the mean age was 52.4 years and 221 (62.1%) were male. The pooled incidences rate of symptoms as follows: pharyngalgia (12.2%, 95% CI: 0.087-0.167), diarrhea (9.2%, 95% CI: 0.062-0.133) and headache (8.9%, 95% CI: 0.063-0.125). Meanwhile, 5.7% (95% CI: 0.027-0.114) of patients were found without any symptoms although they were diagnosed by RT-PCR. In the terms of CT imaging examination, the most of patients showed bilateral mottling or ground-glass opacity, 8.6% (95% CI: 0.048-0.148) of patients with crazy-paving pattern, and 11.5% (95% CI: 0.064-0.197) of patients without obvious CT imaging presentations. The pooled incidence of mortality was 8.9% (95% CI: 0.062-0.126).ConclusionsTo our knowledge, this is the first evidence-based medicine research to further elaborate the clinical characteristics of NCIP, which is beneficial to the next step of prevention and treatment.

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