1.
Iron chelation therapy in patients with low- to intermediate-risk myelodysplastic syndrome: A systematic review and meta-analysis
Yang S, Zhang MC, Leong R, Mbuagbaw L, Crowther M, Li A
British journal of haematology. 2021
-
-
-
Editor's Choice
PICO Summary
Population
Patients with myelodysplastic syndromes (12 studies, n= 3,396).
Intervention
Iron chelation therapy (ICT).
Comparison
No iron chelation therapy.
Outcome
Nine studies reported a consistently longer median overall survival on patients receiving ICT compared to those not receiving iron chelation therapy. Meta-analysis of observational studies showed that ICT was associated with an overall lower risk of mortality. Five studies indicated decreased risk while two indicated increased risk of acute myeloid leukaemia (AML) progression with ICT. Two studies showed a smaller percentage of deaths caused by AML progression, while three studies showed a larger percentage with ICT. In five studies, ICT decreased risk of cardiac injury.
2.
Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic Review and Meta-analysis
Daud SA, Kaur B, McClure GR, Belley-Cote EP, Harlock J, Crowther M, Whitlock RP
Eur J Vasc Endovasc Surg. 2020
-
-
-
Free full text
-
Editor's Choice
Abstract
OBJECTIVE In vascular and cardiac surgery, the ability to maintain haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin based sealants were introduced as a means to prevent or halt bleeding during surgery. Whether fibrin and thrombin sealants affect surgical outcomes is poorly established. A systematic review and meta-analysis was performed to examine the impact of fibrin or thrombin sealants on patient outcomes in vascular and cardiac surgery. DATA SOURCES Cochrane CENTRAL, Embase, and MEDLINE, as well as trial registries, conference abstracts, and reference lists of included articles were searched from inception to December 2019. REVIEW METHODS Studies comparing the use of fibrin or thrombin sealant with either an active (other haemostatic methods) or standard surgical haemostatic control in vascular and cardiac surgery were searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) were used to assess the risk of bias of the included randomised and non-randomised studies; quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two reviewers screened studies, assessed risk of bias, and extracted data independently and in duplicate. Data from included trials were pooled using a random effects model. RESULTS Twenty-one studies (n = 7 622 patients) were included: 13 randomised controlled trials (RCTs), five retrospective, and three prospective cohort studies. Meta-analysis of the RCTs showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL, in favour of sealant use [95% confidence interval {CI} -150.6 - -90.7; p < .001], moderate quality). Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference -2.5 minutes [95% CI -4.0 - -1.1; p < .001], low quality). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data. CONCLUSION The use of fibrin and thrombin sealants confers a statistically significant but clinically small reduction in blood loss and time to haemostasis; it does not reduce blood transfusion. These Results may support selective rather than routine use of fibrin and thrombin sealants in vascular and cardiac surgery.
PICO Summary
Population
Adult patients undergoing major open vascular and cardiac surgical procedures (21 studies, n= 7622).
Intervention
Fibrin or thrombin based sealant to control any source of operative bleeding.
Comparison
Any alternate form of operative haemostasis, including bone wax, other non-fibrin and non-thrombin surgical sealants, polytetrafluoroethylene patch, or manual compression.
Outcome
Meta-analysis of the randomised controlled trials (RCTs) showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL) in favour of sealant use. Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference -2.5 minutes). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data.