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Pediatric Transplantation Jun 2021RGT is a major cause for early graft loss after KTx. Although evidence-based recommendations are lacking, aP is often used to prevent RGT. This systematic review aimed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
RGT is a major cause for early graft loss after KTx. Although evidence-based recommendations are lacking, aP is often used to prevent RGT. This systematic review aimed to determine the effectiveness and safety of aP in adult and pediatric KTx recipients.
METHODS
MEDLINE, EMBASE, Cochrane Controlled Trials Register, conference proceedings, and electronic databases for trial registries were searched for eligible studies using search terms relevant to this review (April 21, 2020). The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Prefered Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement.
RESULTS
Twelve studies comprising 2370 patients (adult = 1415, pediatric = 955) were included, of which three were RCTs. The overall risk for developing RGT was lower in the group with aP compared with the control group (RR 0.24, 95% confidence interval 0.12-0.49). The antithrombotic drugs used were heparin (7/12), acetylsalicylic acid (2/12), a combination of both (2/12), and dipyridamole (1/12) with a high variability in timing, dosing, and mode of application. Adverse effects were reported rarely, with minor bleeding as the main complication. The non-randomized studies had significant risks of bias in the domains of patient selection, confounder, and measurement of outcomes.
CONCLUSION
Based on pooled analysis, aP seems to reduce the risk of RGT in KTx. However, the reliability of these results is limited, as the quality of the available studies is poor and information on adverse effects associated with aP is scarce. Additional high-quality research is urgently needed to provide sufficient data supporting the use of aP in KTx.
Topics: Adult; Child; Dose-Response Relationship, Drug; Drug Administration Schedule; Fibrinolytic Agents; Humans; Kidney Transplantation; Perioperative Care; Postoperative Complications; Renal Artery; Renal Veins; Thrombosis; Treatment Outcome
PubMed: 33826219
DOI: 10.1111/petr.14021 -
Frontiers in Pharmacology 2019Ginkgo leaf extract and dipyridamole injection (GDI), a kind of Chinese medicine preparation, has been considered as a promising supplementary treatment for ischemic...
Ginkgo leaf extract and dipyridamole injection (GDI), a kind of Chinese medicine preparation, has been considered as a promising supplementary treatment for ischemic stroke. The aim of this study was to systematically evaluate the clinical efficacy and safety of GDI mediated therapy for ischemic stroke. PubMed, Cochrane Library, Medline, Embase, Web of Science, Wanfang database, Chinese Scientific Journal Database (VIP), China National Knowledge Infrastructure (CNKI) and Chinese Biological Medicine Database (CBM), were searched systematically for clinical trials of conventional treatments combined with GDI for ischemic stroke. The reported outcomes including overall response, hemorrheology and blood lipid indexes, and adverse events were systematically investigated. Data from thirty-nine trials including 3,182 ischemic stroke patients were involved. The results indicated that, compared with conventional treatments alone, the combination of conventional treatments with GDI obviously improved the overall response (odds ratio [OR] = 4.14, 95% confidence interval [CI] = 3.26-5.25, < 0.00001), neurological status (National Institutes of Health Stroke Scale, OR = -3.13, 95% CI = -3.98 to -2.28, < 0.00001) and activity of daily living (Barthel Index score, OR = 14.10, 95% CI = 9.51-18.68, < 0.00001) of patients. Moreover, the hemorheology and blood lipids indexes of ischemic stroke patients were also significantly ameliorated after the combined therapy ( < 0.01). The frequency of adverse events did not differ significantly between the two groups ( > 0.05). Evidence from the meta-analysis suggested that the combination of conventional treatments and GDI is safe and more effective in treating ischemic stroke than conventional treatments alone. Therefore, GDI mediated therapy could be recommended as an adjuvant treatment for ischemic stroke.
PubMed: 31866861
DOI: 10.3389/fphar.2019.01403 -
Journal of Plastic, Reconstructive &... Aug 2020Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Approximately 2% of the population are anticoagulated and over 50% of over 65-year-olds are prescribed antiplatelet agents. Several systematic reviews have shown the safety of interrupting anticoagulation and antiplatelets for non-emergency surgery, although such reviews excluded upper limb procedures and represents the rationale for this review.
METHODS
The literature was systematically searched for studies concerning the outcomes of adult hand or wrist surgery on patients receiving anticoagulation or antiplatelet agents in direct comparison to controls (no anticoagulation or antiplatelet agents, or interruption of either). The primary outcome was reoperation for any complication related to postoperative bleeding, within 30 postoperative days.
RESULTS
Nine cohort studies (3628 individuals; 3863 operations) were included. Based on very low-quality evidence, anticoagulation did not affect the risk of reoperation for bleeding (RR 2.4 [95% CI 0.1, 57]; 3 studies, n=443) or bruising (RR 2.5 [95% CI 1.0, 6.3]; n=124; I=0%). Based on low quality evidence, antiplatelet agents did not affect the risk of reoperation for bleeding (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=1885; I=0%) or bruising (RR 3.2 [95% CI 0.2, 44]; n=571; I=66%). A sensitivity analysis showed that carpal tunnel decompression on patients receiving anticoagulants or antiplatelets appeared to be safe (RR 0.8 [95% CI 0.3, 1.8]; 6 studies, n=2077; I=0%).
CONCLUSIONS
Given the sparsity of events (bleeding and bruising) and low-quality of the literature, no firm conclusions can be drawn. The decision to interrupt antiplatelets or anticoagulants should be made jointly with expert physicians and the patient. Registration: PROSPERO ID CRD42018087755.
Topics: Anticoagulants; Hand; Hemorrhage; Humans; Platelet Aggregation Inhibitors; Postoperative Complications; Reoperation; Wrist
PubMed: 32499185
DOI: 10.1016/j.bjps.2020.05.017 -
Obstetrics and Gynecology Feb 2017Spontaneous preterm birth is an important cause of neonatal mortality and morbidity. An increasing body of evidence suggests that uteroplacental ischemia plays an... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Spontaneous preterm birth is an important cause of neonatal mortality and morbidity. An increasing body of evidence suggests that uteroplacental ischemia plays an important role in the etiology of spontaneous preterm birth. We aimed to study whether antiplatelet agents reduce the risk of spontaneous preterm birth.
DATA SOURCES
We included data from an individual participant data meta-analysis of studies that had evaluated the effect of antiplatelet agents to reduce preeclampsia (Perinatal Antiplatelet Review of International Studies Individual Participant Data).
METHODS OF STUDY SELECTION
The meta-analysis included 31 studies that randomized women to low-dose aspirin-dipyridamole or placebo-no treatment as a primary preventive strategy for preeclampsia. For the current study we analyzed data from 17 trials (28,797 women) that supplied data on type of delivery (spontaneous compared with indicated birth).
TABULATION, INTEGRATION, AND RESULTS
Primary endpoints were spontaneous preterm birth at less than 37 weeks, less than 34 weeks, and less than 28 weeks of gestation. We analyzed outcomes for each trial separately using χ statistics and combined in an individual participant data meta-analysis using a binary logistic regression model. Women assigned to antiplatelet treatment compared with placebo or no treatment had a lower risk of spontaneous preterm birth at less than 37 weeks (relative risk [RR] 0.93, 95% confidence interval [CI] 0.86-0.996) and less than 34 weeks of gestation (RR 0.86, 95% CI 0.76-0.99). The RR of having a spontaneous preterm birth at less than 37 weeks of gestation was 0.83 (95% CI 0.73-0.95) for women who have had a previous pregnancy and 0.98 (95% CI 0.89-1.09) for women in their first pregnancy. The treatment effect was stable in all other prespecified subgroups.
CONCLUSION
Antiplatelet agents reduce spontaneous preterm birth in pregnant women at risk for preeclampsia.
Topics: Adult; Aspirin; Dipyridamole; Female; Gestational Age; Humans; Logistic Models; Platelet Aggregation Inhibitors; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Risk Factors; Treatment Outcome
PubMed: 28079785
DOI: 10.1097/AOG.0000000000001848 -
European Journal of Vascular and... Aug 2016Many patients using haemodialysis for end-stage renal disease (ESRD) require arteriovenous fistulae (AVF) or grafts. Patency can be variable, and this systematic review... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Many patients using haemodialysis for end-stage renal disease (ESRD) require arteriovenous fistulae (AVF) or grafts. Patency can be variable, and this systematic review aimed to determine the effects of adjuvant drug treatment on the patency of AVFs and grafts.
METHODS
The Cochrane Peripheral Vascular Diseases Group searched the Specialised Register and CENTRAL for all randomised controlled trials (RCTs) investigating the effect of active drug versus placebo on patency. The primary outcome was fistula or graft patency rate. The odds ratio (OR) was used as the measure of effect for each outcome. If several trials assessed the same adjuvant therapy then a meta-analysis was conducted using a Mantel-Haenszel model.
RESULTS
Fifteen trials were deemed suitable for inclusion, investigating nine drug treatments in 2,230 participants. Overall, the quality of evidence was low. Three trials compared ticlopidine (a platelet aggregation inhibitor) versus placebo and favoured active treatment (OR 0.45, 95% CI 0.25 to 0.82; p = .009). Three RCTs assessed aspirin versus placebo and did not show a statistical benefit (OR 0.40, 95% CI 0.07-2.25; p = .30). Two trials compared clopidogrel with placebo. The overall result did not favour treatment (OR 0.40, 95% CI 0.13 to 1.19; p = .10). Three trials evaluated human type-I pancreatic elastase but did not provide evidence of improved patency (OR 0.75, 95% CI 0.42-1.32; p = .31). Finally, two RCTs assessed fish oil and did not favour treatment (OR 0.24, 95% CI 0.03-1.95; p = .18). Single trials comparing dipyridamole alone, dipyridamole plus aspirin, and sulfinpyrazone against placebo favoured active treatment but a meta-analysis could not be undertaken. Finally, a single trial of warfarin versus placebo found warfarin resulted in increased complications and worse patency rates.
CONCLUSION
This systematic review has not demonstrated a beneficial effect for any adjuvant treatment to increase the patency of AVF or grafts in the short term, except ticlopidine which has been taken off the market.
Topics: Anticoagulants; Arteriovenous Shunt, Surgical; Chemotherapy, Adjuvant; Hematologic Agents; Humans; Platelet Aggregation Inhibitors; Vascular Grafting; Vascular Patency
PubMed: 27289558
DOI: 10.1016/j.ejvs.2016.04.016 -
Schizophrenia Research Sep 2013Adenosine has been reported to interact with dopamine and glutamate of which are currently central pathophysiology of schizophrenia. Further, there have been emerging... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Adenosine has been reported to interact with dopamine and glutamate of which are currently central pathophysiology of schizophrenia. Further, there have been emerging reports that patients with bipolar disorder (BD) have pathophysiological changes of the purinergic system. Thus, we performed a systematic review and meta-analysis of adenosine modulators in these disorders.
METHOD
We searched PubMed, EMBASE, the Cochrane Library databases, CINAHL, and PsycINFO up to April 25, 2013. Randomized controlled trials comparing adenosine modulator adjuvant therapy with placebo in patients with schizophrenia and BD were included. Primary outcome measures were Positive and Negative Syndrome Scale (PANSS) and Young Mania Rating Scales (YMRS). The risk ratio, 95% confidence interval, and standardized mean differences (SMD) were used.
RESULTS
Nine studies, including six studies in schizophrenia (total n=457) and three studies in BD (total n=289) were included. Overall, adenosine modulators were superior to placebo in PANSS total scores (SMD=-1.07, p=0.01) and positive and general but not negative symptom subscale scores in schizophrenia. Individually, allopurinol failed to show its superiority to placebo in all primary outcome measures in schizophrenia. In BD, data from pooled adenosine modulators indicated significant reduction of YMRS scores in comparison to placebo (SMD=-0.39, p=0.004).
CONCLUSIONS
Our results suggest that adenosine modulator adjuvant therapy is more beneficial in overall psychopathology (especially positive symptoms) in schizophrenia and in treating mania episodes of BD in comparison to placebo. The limited sample size of available studies suggests that more research should be done to evaluate both efficacy and tolerability of these medications.
Topics: Adenosine; Antipsychotic Agents; Bipolar Disorder; Databases, Factual; Humans; Purinergic Agents; Randomized Controlled Trials as Topic; Schizophrenia
PubMed: 23870805
DOI: 10.1016/j.schres.2013.06.038 -
Medicine May 2021In recent years, the incidence rate of hypertensive nephropathy has been increasing quickly, which has been a major threat to people's health.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In recent years, the incidence rate of hypertensive nephropathy has been increasing quickly, which has been a major threat to people's health. Renin-angiotensin-aldosterone system blockers have certain curative effects. However, there are some patients having serious adverse reactions, and the benefit population is limited, so the treatment of hypertensive renal damage is necessary to have beneficial supplement. More and more clinical studies have shown that ginkgo leaf extract and dipyridamole injection (GDI) combined with antihypertensive drugs has achieved good results in the treatment of hypertensive renal damage. It is supposed to be a supplementary treatment in hypertensive nephropathy.
OBJECTIVES
To systematically assess the efficacy and safety of GDI combined with antihypertensive drugs on hypertensive renal injury.
METHODS
Seven databases including PubMed, Cochrane Library, Embase, Wanfang database, China biomedical literature service system (Sino Med), VIP Chinese Sci-tech journal database (VIP), and China national knowledge internet (CNKI) were retrieved to collect randomized controlled trials (RCTs) in the experimental group containing combined therapy of hypertensive nephropathy with GDI and antihypertensive drugs. The retrieval time was from the establishment of database to July 8, 2020. Two researchers independently selected literature, extracted data, and evaluated the risk of bias in the study. The methodological quality was evaluated with Cochrane handbook and meta-analysis was performed with Stata 14.0 software.
RESULTS
Eight studies were included in this study which involved 556 patients. The meta-analyses indicated that, compared with using antihypertensive drugs alone, combined treatment of GDI with antihypertensive drugs can decrease 24-hour urinary total protein (weighted mean difference [WMD] -0.61, 95% confidence interval [CI]: -0.82, -0.39; k = 6, P ≤ .001), blood urea nitrogen (WMD -1.27, 95% CI: -2.45, -0.10; k = 6, P = .033, serum creatinine (WMD -29.50, 95% CI: -56.44, -2.56; number of estimates [k] = 6, P = .032).
CONCLUSIONS
Our meta-analyses showed that GDI combined with antihypertensive drugs can improve the renal function of hypertensive patients with renal injury.
Topics: Antihypertensive Agents; Dipyridamole; Drug Therapy, Combination; Drugs, Chinese Herbal; Ginkgo biloba; Hematologic Tests; Humans; Hypertension, Renal; Nephritis; Plant Extracts; Randomized Controlled Trials as Topic; Urinalysis; Vasodilator Agents
PubMed: 34106629
DOI: 10.1097/MD.0000000000025852 -
Journal of Integrative and... Dec 2022The aim of this study was to compare the efficacy of different injected Traditional Chinese Medicines in the treatment of diabetic retinopathy (DR) and to provide a... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to compare the efficacy of different injected Traditional Chinese Medicines in the treatment of diabetic retinopathy (DR) and to provide a reference for the selection of adjuvant therapy for DR. Related literature in multiple biological databases and websites was searched up to April 15, 2022, without language and publication time restrictions. A Bayesian network meta-analysis was used to analyze the included studies. Compared with conventional treatment, the combined use of injected Traditional Chinese Medicines, including astragalus, danhong, extract powder, ginkgo leaf extract and dipyridamole (GLED), ligustrazine (LIG), mailuoning, puerarin, safflower, shuxuetong, safflower yellow sodium chloride, and xueshuantong (XST), can significantly improve the clinical effectiveness in patients with DR, while LIG, XST, and GLED can improve vision. The strength of the evidence ranged from high to very low. In patients with DR, the combination of multiple injected Traditional Chinese Medicines is more effective than conventional treatment; some of these medicines may also improve visual acuity. This study may provide a good resource and reference for the selection of adjuvant therapy for DR.
Topics: Humans; Bayes Theorem; Diabetes Mellitus; Diabetic Retinopathy; Network Meta-Analysis; Randomized Controlled Trials as Topic; Medicine, Chinese Traditional
PubMed: 35861710
DOI: 10.1089/jicm.2021.0392 -
American Journal of Kidney Diseases :... Feb 2009Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are related conditions with similar clinical features of variable severity. The objective... (Review)
Review
BACKGROUND
Hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are related conditions with similar clinical features of variable severity. The objective of this systematic review is to evaluate the benefits and harms of available interventions for HUS and TTP.
SELECTION CRITERIA FOR STUDIES
MEDLINE (1966 to June 2006), EMBASE (1980 to June 2006), the Cochrane Central Register, conference proceedings, and reference lists were searched to find randomized controlled trials (RCTs) of any intervention for HUS or TTP in patients of all ages selected for inclusion for this systematic review.
INTERVENTIONS
Trials that compared an intervention with placebo, an intervention with supportive therapy, or one or more different interventions for HUS or TTP.
OUTCOMES
For TTP trials, failure of remission at 2 weeks or less and at 1 month or longer, all-cause mortality rate, and relapse rate. For HUS trials, all-cause mortality, chronic reduced kidney function, and persistent proteinuria or hypertension at last follow-up.
RESULTS
For TTP in adults, we found 6 RCTs of 331 patients. Two trials compared plasma infusion with plasma exchange using fresh frozen plasma and showed failure of remission at 2 weeks (2 trials, 140 patients; relative risk, 2.87; 95% confidence interval, 1.41 to 5.84), and all-cause mortality (relative risk, 1.91; 95% confidence interval, 1.09 to 3.33) occurred more frequently in the plasma infusion group. Three trials compared plasma exchange using cryosupernatant plasma with plasma exchange using fresh frozen plasma, and a meta-analysis of these trials showed no difference. Seven RCTs in 476 young children with postdiarrheal HUS have been conducted. None of the evaluated interventions (fresh frozen plasma transfusion, heparin with or without urokinase or dipyridamole, Shiga toxin-binding protein, and steroid) were superior to supportive therapy alone for any outcomes.
LIMITATIONS
Limitations of this review include the small number and suboptimal quality of reporting of included trials, possibility of publication bias, small number of participants with atypical HUS, and failure to report results for patients with atypical and typical HUS separately.
CONCLUSIONS
No additional therapy has been shown to increase efficacy over plasma exchange for TTP. No intervention has been shown to be superior to supportive therapy in patients with postdiarrheal HUS.
Topics: Hemolytic-Uremic Syndrome; Humans; Plasma Exchange; Purpura, Thrombotic Thrombocytopenic; Randomized Controlled Trials as Topic
PubMed: 18950913
DOI: 10.1053/j.ajkd.2008.07.038 -
The Cochrane Database of Systematic... 2003Patients with transient ischaemic attacks (TIA) and minor ischaemic strokes are at risk of serious vascular events (death from all vascular causes, non-fatal stroke, or... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients with transient ischaemic attacks (TIA) and minor ischaemic strokes are at risk of serious vascular events (death from all vascular causes, non-fatal stroke, or non-fatal myocardial infarction). Their risk of vascular events lies between 4 and 11 percent per year. Aspirin only, in a daily dose of 30 mg or more, offers only modest protection in such patients: it reduces the incidence of major vascular events by 13 percent. In a single trial, adding dipyridamole (an alternative antiplatelet agent) to aspirin was associated with a 22 percent reduction in the risk of major vascular events compared with aspirin alone. However, a systematic review of all trials of antiplatelet agents by the Antithrombotic Trialists' Collaboration showed that, in high risk patients, there was virtually no difference between the aspirin-dipyridamole combination and aspirin alone. We therefore sought to assess the effects of dipyridamole in more detail.
OBJECTIVES
1) To assess the efficacy of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease in the presence and absence of other antiplatelet drugs. 2) To assess the safety of dipyridamole versus control in the secondary prevention of vascular events in patients with vascular disease in the presence and absence of other antiplatelet drugs.
SEARCH STRATEGY
The Cochrane Stroke Group Trials Register was searched and other relevant Cochrane Groups were contacted to search their specialised registers (last search 29 April 2002). In addition the Cochrane Controlled Trials Register, MEDLINE and EMBASE were searched and Dutch manufacturers of dipyridamole were contacted to identify further published and unpublished studies.
SELECTION CRITERIA
Randomised long term secondary prevention trials with concealed treatment allocation, treatment for > 1 month, starting within 6 months after presentation of a arterial vascular disease were selected (coronary artery disease, myocardial infarction, angina pectoris, retinopathy, nephropathy, peripheral arterial disease, stroke, TIA, amaurosis fugax). Therapy consisted of dipyridamole in any dose in the presence or absence of other antiplatelet drugs compared with no drug or an antiplatelet drug(s) other than dipyridamole (control group).
DATA COLLECTION AND ANALYSIS
Two reviewers selected trials which met the inclusion criteria and extracted details of randomisation methods, blinding of treatments and assessments, whether intention-to-treat analysis was possible from the published data, whether treatment groups were comparable with regard to major prognostic factors, the number of patients who were excluded or lost to follow-up, definition of outcome events, and entry and exclusion criteria. The methodological quality of each trial was assessed by the two reviewers on the basis of these extracted data. In addition, dose and type of antiplatelet treatments, duration of follow-up and the numbers of defined outcome events were recorded. Data published by the Antithrombotic Trialists' Collaboration were used. The remaining data were independently extracted by the same two reviewers and cross checked. Data were analysed according to the intention-to-treat principle. Relative and absolute risk reductions were calculated by means of the statistical software provided by the Cochrane Collaboration (RevMan).
MAIN RESULTS
Twenty-six trials were included, with a total of 19842 patients, among whom 1399 vascular deaths and 3085 fatal and non-fatal vascular events occurred during follow-up. Compared with control, dipyridamole had no clear effect on vascular death (RR 1.02, 95% CI 0.90 to 1.17). This result was not influenced by the dose of dipyridamole or type of presenting vascular disease. Compared with control, dipyridamole appeared to reduce the risk of vascular events (RR 0.90, 95% CI 0.83 to 0.98), but this effect was only statistically significant due to a single large trial in patients presenting with cerebral ischaemia (6602 patients). Comparing dipyridamole plus aspirin with aspirin alone: there was no clear difference in vascular death, the RR was 1.03 (95% CI 0.87 to 1.22); the combination was associated with fewer vascular events with an RR of 0.90 (95% CI 0.80 to 1.00). Combination treatment of dipyridamole and aspirin compared with placebo had an RR of 0.89 (95% CI 0.79 to 1.01) for vascular death and an RR of 0.74 (95% CI 0.68 to 0.80) for vascular events.
REVIEWER'S CONCLUSIONS
This review found that, for patients who presented with arterial vascular disease, there was no evidence that dipyridamole, in the presence or absence of an other antiplatelet drug (chiefly aspirin) reduced the risk of vascular death, though it may reduce the risk of further vascular events. However, this benefit was found in only a single large trial and only in patients presenting after cerebral ischaemia. There was no evidence that dipyridamole alone was more efficacious than aspirin. Further trials comparing the effects of the combination of dipyridamole with aspirin with aspirin alone are justified.
Topics: Anticoagulants; Aspirin; Cerebrovascular Disorders; Dipyridamole; Fibrinolytic Agents; Humans; Ischemic Attack, Transient; Myocardial Infarction; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Stroke; Vascular Diseases
PubMed: 12535415
DOI: 10.1002/14651858.CD001820