1.
Convalescent Plasma Therapy for COVID-19 in Ambulatory vs Hospitalized Patients: Efficacy and Risk of Thromboembolism
Li PY, Yu P, Li A, Khalid F, Laureano ML, Crowther MA
Research and practice in thrombosis and haemostasis. 2023;:100068
Abstract
BACKGROUND While early evidence concluded a lack of clinical benefit of convalescent plasma therapy (CPT) in COVID-19 management, recent trials demonstrate the therapeutic potential of CPT in ambulatory care. CPT may also potentiate thromboembolic events given the presence of coagulation factors and the prothrombotic state of COVID-19. OBJECTIVE The present study aims to assess and compare the clinical efficacy and the risk of venous/arterial thromboembolism (VTE, ATE) of CPT in ambulatory vs hospitalized COVID-19 patients. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched from December 2019 to December 2022 for randomized controlled trials that investigated the use of CPT against placebo or standard of care in adult COVID-19 patients. The primary outcome was non-mortality disease progression. Secondary outcomes include VTE, ATE, 28-day mortality, clinical improvement, length of hospitalization (LOH), sepsis/fever, and major adverse cardiovascular events (MACE). RESULTS Twenty randomized controlled trials, with 21340 patients, were included. CPT significantly reduced non-mortality disease progression in ambulatory patients (OR 0.72, 0.56-0.92, P = 0.009) but not in hospitalized patients (1.03, 0.94-1.12, P = 0.58). The risk of VTE and ATE did not differ between the CPT and the control group (1.15, 0.81 to 1.64, P = 0.44; 1.01, 0.37 to 2.79, P = 0.98). No conclusive differences between CPT and control were noted in 28-day mortality, clinical improvement, LOH, risk of sepsis/fever, and MACE. CONCLUSIONS In conclusion, treatment of COVID-19 with CPT prevents the progression of COVID-19 in the ambulatory care. It is not associated with an increased risk of VTE, ATE, or other adverse events.
2.
The efficacy and safety of thrombopoietin receptor agonists in patients with chronic liver disease undergoing elective procedures: a systematic review and meta-analysis
Lindquist I, Olson SR, Li A, Al-Samkari H, Jou JH, McCarty OJT, Shatzel JJ
Platelets. 2021;:1-7
Abstract
Thrombopoietin receptor agonists (TPO-RAs) can mitigate preprocedural thrombocytopenia in patients with chronic liver disease (CLD) however their effects on procedural outcomes is unclear. In this meta-analysis, we aimed to better define the efficacy, thrombotic risk and bleeding mitigation associated with the use of preoperative TPO-RAs in patients with CLD. We performed a systematic review and meta-analysis of randomized placebo-controlled clinical trials to assess the use of preprocedural TPO-RAs in patients with CLD, searching MEDLINE, EMBASE and the Cochrane library database. Six publications comprising eight randomized trials (1229 patients; 717 received TPO-RAs, 512 received placebo) and three unique TPO-RAs were retrieved. The majority of the included procedures were endoscopic. TPO-RAs were significantly more likely to result in a preoperative platelet count greater than 50 x 10(9)/L (72.1% vs 15.6%, RR 4.8, 95% CI 3.6-6.4 p < .00001. NNT 1.8) and reduced the incidence of platelet transfusions (22.5% vs 67.8%, RR 0.33, 95% CI 0.3-0.4 p < .00001. NNT 2.2). Total periprocedural bleeding was decreased in patients who received TPO-RAs (11.6% vs 15.6%, RR 0.64, 95% CI 0.5-0.9 p = .01. NNT 24.7) and there was no increase in the rate of thrombosis (2.2% vs 1.8% RR 1.25, 95% CI 0.6-2.9 p = .60. NNH 211.1). In patients with CLD the use of preprocedural TPO-RAs resulted in significant increased platelet counts, and decreased the incidence of platelet transfusions as compared to placebo. TPO use likewise decreased the incidence of total periprocedural bleeding without increasing the rate of thrombosis.
3.
Drug-drug interactions with direct oral anticoagulants associated with adverse events in the real world: A systematic review
Li A, Li MK, Crowther M, Vazquez SR
Thrombosis Research. 2020
Abstract
Background: Direct oral anticoagulants (DOACs) have emerged as safe and effective alternatives to Vitamin-K antagonists for treatment and prevention of arterial and venous thrombosis Due to their novelty, pharmacokinetic DOAC drug-drug interactions (DDIs) that result in clinical adverse events have not been well-documented Objective: This study aims to systematically review reported pharmacokinetic DDIs resulting in clinical adverse events through documented observational evidence to better inform clinicians in clinical practice Methods: A comprehensive literature review of EMBASE, MEDLINE, and Ovid HealthStar was conducted through March 10th, 2020 Two independent reviewers screened and extracted data from eligible articles according to pre-established inclusion and exclusion criteria Articles reporting bleeding or thrombotic outcomes in non-controlled (observational) settings resulting from suggested pharmacokinetic DOAC DDIs were included Results: A total of 5567 citations were reviewed, of which 24 were included following data extraction The majority were case reports (n = 21) documenting a single adverse event resulting from a suspected DOAC DDI, while the remaining papers were a case series (n = 1) and cohort studies (n = 2) The most commonly reported interacting drugs were amiodarone and ritonavir (bleeding), and phenobarbital, phenytoin, and carbamazepine (thrombosis) Bleeding events more often resulted from a combined mechanism (P-glycoprotein AND CYP3A4 inhibition), whereas thrombotic events resulted from either combined OR single P-glycoprotein/CYP3A4 induction Conclusion: Current literature evaluating the real-world risk of DOAC DDIs is limited to few case reports and retrospective observational analyses Clinicians are encouraged to continue to report suspected drug interactions resulting in adverse events
4.
Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis
Li A, Wang H, Yu Z, Zhang G, Feng S, Liu L, Gao Y
Medicine. 2019;98(51):e18358
Abstract
OBJECTIVE The aim of this meta-analysis was to compare the effectiveness of platelet-rich plasma (PRP) vs corticosteroids for treatment of patients with lateral elbow epicondylitis. METHODS A literature search was performed in EMBASE, Medline, the Cochrane Library and PubMed. Randomized controlled studies comparing PRP with corticosteroids for the treatment of epicondylitis were included. The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the methodological quality of the included trials. The Cochrane Collaboration's Review Manager software was used to perform the meta-analyses. The overall effect size of each anesthetic was calculated as the weighted average of the inverse variance of the study-specific estimates. RESULTS Seven randomized controlled trials were included in this review. The data from 2 studies were unavailable for meta-analysis, and the systematic review criteria were just achieved. Local corticosteroid injection yielded a significantly superior Disabilities of the Arm, Shoulder and Hand (DASH) score at 4 weeks (WMD, 11.90; 95% CI: 7.72 to 16.08; P < .00001; heterogeneity, chi = 0, I = 0%, P = 1.00) and 8 weeks (WMD, 6.29; 95% CI: 2.98 to 9.60; P = .0002, chi = 0, I = 0%, P = 1.00). Otherwise, it was noteworthy that a significantly lower VAS score (WMD, -2.61; 95% CI: -5.18 to -0.04; P = .05; heterogeneity, chi = 29.85, I = 97%, P < .00001) and DASH score (WMD, -7.73; 95% CI: -9.99 to -5.46; P < .00001, chi = 0.20, I = 0%, P = .66) existed in the PRP regimen than in the steroid regimen at the 24-week follow-up. More effective treatments were achieved in the PRP-treated patients than in the patients treated with corticosteroids (WMD, 3.33; 95% CI: 1.81 to 6.14; P = .000; heterogeneity, chi = 0.43, I = 0%, P = .51). CONCLUSIONS Local corticosteroid injections demonstrated favorable outcomes compared with those of local PRP treatments for lateral elbow epicondylitis during the short-term follow-up period (4 weeks and 8 weeks post-treatment). Otherwise, at the long-term follow-up (24 weeks post-treatment), PRP injections had improved pain and function more effectively than corticosteroid injections.