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Network meta-analysis of platelet-rich fibrin in periodontal intrabony defects
Ye L, Mashrah MA, Ge L, Fang Y, Guo X, Ge Q, Wang L
Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 2023
Abstract
OBJECTIVES To evaluate the effect of platelet-rich fibrin alone or in combination with different biomaterials for the treatment of periodontal intra-bony defect. METHODS Up to April 2022, Cochrane library, Medline, EMBASE, and Web of Science databases were searched for randomized clinical trials. The outcomes of interest were probing pocket depth reduction, clinical attachment level gain, bone gain, and bone defect depth reduction. Bayesian network meta-analysis with 95% credible intervals was calculated. RESULTS Thirty-eight studies with 1,157 participants were included. Platelet-rich fibrin alone or platelet-rich fibrin +biomaterials showed a statistically significant difference when compared with open flap debridement (P<0.05, low to high certainty evidence). Neither biomaterials alone nor platelet-rich fibrin +biomaterials showed a statistically insignificant difference when compared to platelet-rich fibrin alone (P>0.05, very low to high certainty evidence). Platelet-rich fibrin +biomaterials showed insignificant differences as compared to biomaterials alone (P>0.05, very low to high certainty evidence). Allograft +collagen membrane ranked the best in probing pocket depth reduction while platelet-rich fibrin +hydroxyapatite ranked the best in bone gain. CONCLUSION It seems that 1) Platelet-rich fibrin with/without biomaterials were more effective than open flap debridement. 2) Platelet-rich fibrin alone provides a comparable effect to biomaterials alone and platelet-rich fibrin +biomaterials. 3)Platelet-rich fibrin +biomaterials provide a comparable effect to biomaterials alone. Although allograft +collagen membrane and platelet-rich fibrin +hydroxyapatite ranked the best in terms of probing pocket depth reduction and bone gain respectively, the difference between different regenerative therapies remains insignificant, and therefore, further studies are still needed to confirm these results.
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2.
Comparison of intravenous versus topical tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of ten randomized trials
Fang Y, Shang X
Journal of comparative effectiveness research. 2021
Abstract
Aim: The optimal management approach for tranexamic acid (TXA) in primary total hip arthroplasty (THA) is still controversial. This meta-analysis aimed to evaluate the efficacy and safety of intravenous versus topical TXA during THA. Materials & methods: PubMed, Google Scholar, Embase and the Cochrane library were searched for all randomized controlled trials comparing topical and intravenous TXA (iTXA) following primary THA. The primary outcome consisted of blood loss including total blood loss, intraoperative blood loss and hidden blood loss (HBL), hemoglobin (Hb) level of postoperative day 1, maximum Hb drop and transfusion incidence. The second outcome included drainage volume, complications and length of stay. Extracted data were statistically analyzed with the Stata11.0. Results: A total of ten randomized controlled trials containing 1295 patients were included in the study. A similar effect of transfusion rate, total blood loss, Hb level of postoperative day 1, drainage volume, deep vein thrombosis events and wound complications appeared in the two routes. Intraoperative blood loss (weighted mean difference [WMD] = -12.687, 95% CI: -22.291, -3.083; p = 0.010), HBL (WMD = 14.276, 95% CI: 9.936, 19.459; p < 0.001) and maximum Hb drop (WMD = -0.400, 95% CI: -0.577, -0.222; p < 0.001) were significantly reduced in the intravenous group compared with topical group. Conclusion: The present result indicated comparable safety and transfusion rate for intravenous and topical TXA in primary THA, while the intravenous approach demonstrated a smaller intraoperative blood loss, HBL and maximum Hb drop.
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3.
Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty: a meta-analysis
Zhang P, Liang Y, Chen P, Fang Y, He J, Wang J
Bmc Musculoskeletal Disorders. 2017;18((1)):90.
Abstract
BACKGROUND The use of intravenous (IV) or topical tranexamic acid (TXA) in total hip arthroplasty has been proven to be effective and safe in total hip arthroplasty. However, which of these two administration routes is better has not been determined. The combined administration of TXA has been used in total knee arthroplasty with satisfactory results. We hypothesized that combined application of TXA may be the most effective way without increased rate of thrombotic events such as deep vein thrombosis (DVT) and pulmonary embolisms (PE) in patients subjected to primary total hip replacement (THA). A meta-analysis was conducted to compare the efficacy and safety of the combined use of tranexamic acid (TXA) relative to topical or intravenous (IV) use alone for treatment of primary THA. The outcomes included total blood loss, postoperative hemoglobin decline, transfusion rates, and the incidence rates of deep vein thrombosis (DVT) and pulmonary embolisms (PE). METHODS We searched electronic databases including PubMed, EMBASE, the Cochrane Library, Web of Science, the Chinese Biomedical Literature database, the CNKI database, and Wanfang Data until September 2016. The references of the included articles were also checked for additional potentially relevant studies. There were no language restrictions for the search. The data of the included studies were analyzed using RevMan 5.3 software. RESULTS Seven studies met the inclusion criteria, encompassing a total of 1762 patients. Our meta-analysis demonstrated that total blood loss, postoperative hemoglobin decline, and transfusion rates were significantly lower for patients that received the combined treatment compared to patients that received either topical or intravenous administration of TXA. No statistical differences were found in the incidence of deep venous thrombosis (DVT) or pulmonary embolism (PE). CONCLUSION The group that received the combined treatment had lower total blood loss, postoperative hemoglobin decline, and transfusion rates without an increased rate of thrombotic events (DVT or PE). The topical or intravenous use of TXA in primary THA is generally considered to be safe and effective. This meta-analysis demonstrated that combined TXA application may be superior to topical or intravenous application of TXA alone. However, larger, high-quality randomized control trials are required for greater confidence in this finding.
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4.
Timing of tourniquet release in total knee arthroplasty: a meta-analysis
Zhang P, Liang Y, He J, Fang Y, Chen P, Wang J
Medicine. 2017;96((17)):e6786.
Abstract
BACKGROUND For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications. METHODS To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Methodological quality of the trials was assessed using the Cochrane risk assessment scale. The data of the included studies were analyzed using Stata 12.0. RESULTS Sixteen trials involving 1010 patients were identified in current meta-analysis. Our meta-analysis demonstrated that there were no significant differences in the 2 groups in terms of calculated blood loss (weighted mean difference [WMD] = 160.65, 95% confidence interval [CI]: -0.2 to 321.49, P = .05), postoperative blood loss (WMD = -45.41, 95% CI: -120.11 to 29.29, P = .233),postoperative hemoglobin decline (WMD = 0.16, 95% CI: -2.5 to 2.82, P = .905), transfusion volume (WMD = 79.19, 95% CI: -5.05 to 163.44, P = .065),transfusion rates (relative risk [RR] = 1.19, 95% CI: 0.95-1.50, P = .134), major complications (RR = 0.51, 95% CI: 0.15-1.73, P = .278), and deep vein thrombosis (RR = 0.44, 95% CI: 0.14-1.37, P = .157).Compared with the group of releasing tourniquet after wound closure, the group of releasing tourniquet before wound closure had a higher volume of total blood loss (WMD = 130.96, 95% CI: 58.83-203.09, P = .000) and a longer operation time (WMD = 6.56, 95% CI: 3.12-10.01, P = .000). However, releasing tourniquet before wound closure could reduce minor complications (RR = 0.53, 95% CI: 0.34-0.82, P = .004). CONCLUSIONS On the basis of current meta-analysis, the method of releasing tourniquet before wound closure could increase total blood loss and operation time; nevertheless, the risk of complications decreased. Thus, if patients are in severe anemia condition, the tourniquet perhaps should be released after wound closure to decrease blood loss. In contrary, releasing tourniquet before wound closure to decrease the risk of complications would be a better choice.
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Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: a meta-analysis
Zhang P, He J, Fang Y, Chen P, Liang Y, Wang J
Medicine. 2017;96((21)):e6940.
Abstract
BACKGROUND Patients undergoing hip fracture surgery frequently require blood transfusion. Tranexamic acid (TXA) has been widely used to decrease blood loss and transfusion rates in joint replacement surgery. Therefore, we conducted a meta-analysis to evaluate efficacy and safety of intravenous TXA administration in patients suffering from hip fractures. METHODS Electronic databases were searched before December 2016 by 2 independent reviewers, including Cochrane Library, EMBASE, PubMed, Web of Science, the Chinese Biomedical Literature database, and the China National Knowledge Infrastructure databases. Randomized controlled trials (RCTs) involving the efficacy and safety of intravenous (IV) TXA in patients who underwent hip surgery were included in our meta-analysis. The endpoints included total blood loss, hidden blood loss, postoperative hemoglobin decline, transfusion rates, the rate of thrombotic events, and operative time. Current meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The pooling of data was carried out using STATA V.12.0 software. RESULT Eight RCTs were included, involving 598 participants. Current meta-analysis indicated that the IV TXA group had less total blood loss (weighted mean difference [WMD] = -277, 95%CI: -335 to -220, P = .000), less hidden blood loss (WMD = -246, 95%CI: -252 to -241, P = .000), lower postoperative hemoglobin decline (WMD = -1.36, 95% CI: -1.84 to -0.88, P = .000), and lower transfusion rates (risk difference [RD] = -0.19, 95% CI: -0.27 to -0.11, P = .000) compared to the control group. No significant differences were found regarding the rate of thrombotic events (RD = 0.02, 95% CI: = -0.01 to 0.05, P = .262) and operative time (WMD = -0.7, 95% CI: -3.3 to 1.9, P = .6). CONCLUSION It was well established that systemic administration of TXA could reduce blood loss and transfusion rates in hip fracture surgery. But the optimal regimen, dosage, and timing still need a further research. In addition, more large and high-quality randomized controlled studies are needed to focus on the safety of IV TXA application before its wide recommendation for use in hip fracture surgery.
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6.
Intravenous versus topical tranexamic acid in primary total hip replacement: a meta-analysis
Zhang P, Liang Y, Chen P, Fang Y, He J, Wang J
Medicine. 2016;95((50)):e5573.
Abstract
BACKGROUND As the prevalence of total hip arthroplasty (THA) is increasing, it is usually associated with considerable blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip joint arthroplasty. But the best route of TXA administration continues to be controversial. So, we conducted a meta-analysis that integrated all data from the 7 included trials to compare the effectiveness and safety of topical and intravenous TXA administration in primary THA. The endpoints assessed in this meta-analysis include the comparisons of total blood loss, postoperative hemoglobin decline, transfusion rates, the incidence rate of deep vein thrombosis (DVT), pulmonary embolisms (PE), and wound infection. METHODS Literature searches of PubMed, EMBASE, the Cochrane Library, the Chinese Biomedical Literature database, the CNKI database, and Wan Fang Data were performed up to August 30, 2016. Randomized controlled trials (RCTs) were included in our meta-analysis if they compared the efficiency and safety of intravenous versus topical administration of TXA in patients who underwent primary THA. The endpoints included the comparisons of total blood loss, postoperative hemoglobin decline, transfusion rates, the incidence rate of DVT, PE, and wound infection. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The pooling of data was carried out by using RevMan 5.3, Denmark. RESULTS Seven RCTs involving 964 patients met the inclusion criteria. Our meta-analysis indicated that there were no significant differences in the 2 groups in terms of total blood loss ([mean difference (MD) = -14.74, 95% confidence interval (CI): -89.21 to 59.74, P = 0.7], transfusion rates [RD = -0.02, 95% CI: -0.05 to 0.02, P = 0.39]; no significant differences were found regarding the incidence of adverse effects such as deep venous thrombosis [DVT] [RD = 0.00, 95% CI: -0.01 to 0.01, P = 1.00], PE [RD = 0.00, 95% CI: -0.01 to 0.01, P = 0.71], or wound infection [RD = -0.01, 95% CI: -0.06 to 0.04, P = 0.66]). The pooled results showed that the intravenous groups had a lower postoperative hemoglobin decline (MD = -0.47, 95% CI: -0.74 to -0.20, P = 0.0006). It was probably due to insufficient data and the varied reporting of outcomes. There was some inherent heterogeneity due to the small sample size of each primary study. CONCLUSION The topical and intravenous administrations of TXA have a similar effect on the decrease of blood loss without an increased risk of complications (DVT, PE, and wound infection). Intravenous TXA administration may have a maximum efficacy. Topical TXA administration may be preferred in patients who with high risk of thromboembolic events. However, larger, high-quality RCTs are required to explore the optimal regimen, dosage, timing still in the future in order to recommend TXA widespread use in total joint arthroplasty.