1.
Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients: A systematic review and meta-analysis
Zhu C, Yin J, Wang B, Xue Q, Gao S, Xing L, Wang H, Liu W, Liu X
Medicine. 2019;98(32):e16795
Abstract
BACKGROUND Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery. METHODS Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I test. Both Begg and Egger tests were used to assess potential publication bias. RESULTS We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion (P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome (P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents (P <.05). CONCLUSION In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.
2.
Intra-articular platelet-rich plasma injections for knee osteoarthritis: an overview of systematic reviews and risk of bias considerations
Xing D, Wang B, Zhang W, Yang Z, Hou Y, Chen Y, Lin J
International Journal of Rheumatic Diseases. 2017;20((11):):1612-1630
Abstract
OBJECTIVES Numerous systematic reviews investigating the efficacy of platelet-rich plasma (PRP) in treating knee osteoarthritis (OA) have been recently published. The purpose of the present study was (1) to perform an overview of overlapping systematic reviews investigating PRP for knee OA via evaluating methodological quality and risk of bias of systematic reviews and (2) to provide recommendations through the best evidence. METHODS A systematic search of systematic reviews published through Feb 2017 was conducted using the MEDLINE, EMBASE and Cochrane Library. The methodological quality and risk of bias of included systematic reviews were assessed by AMSTAR instrument and ROBIS tool respectively. Best evidence choice procedure was conducted according to the Jadad decision algorithm. The systematic reviews with high quality of methodology and low risk of bias were selected ultimately. RESULTS Ten systematic reviews were eligible for inclusion. The Jadad decision making tool suggested that the reviews with highest AMSTAR score should be selected. According to the ROBIS tool, there were 4 systematic reviews with low risk of bias and 6 with high risk of bias. As a result, two systematic reviews conducted by Dai et al and Meheux et al with highest AMSTAR score and low risk of bias were selected as the best evidence. CONCLUSIONS The present overview demonstrates that PRP is an effective intervention in treating knee OA without increased risk of adverse events. Therefore, the present conclusions may help decision makers interpret and choose PRP with more confidence.
3.
The effect of platelet-rich plasma on reducing blood loss after total knee arthroplasty: A systematic review and meta-analysis
Ma J, Sun J, Guo W, Li Z, Wang B, Wang W
Medicine.. 2017;96((26)):e7262.
Abstract
BACKGROUND Efficacy and safety of platelet-rich plasma (PRP) compared with control for preventing postoperative bleeding after total knee arthroplasty (TKA) is controversial. We performed a meta-analysis of randomized controlled trials (RCTs) to determine whether PRP might reduce blood loss and improve function following TKA. METHODS PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify RCTs comparing PRP with control for patients undergoing unilateral TKA. The mean difference (MD) of total blood loss, hemoglobin (Hb) level, Hb drop, drain volume, range of motion (ROM), Western Ontario and McMaster Osteoarthritis Index (WOMAC) scores, length of hospital stay (LOS), and odds ratios of transfusion rate and postoperative complications in the PRP and control groups were pooled throughout the study. Relevant data were meta-analyzed using RevMan v5.3. RESULTS Six RCTs involving 529 patients were included (208 PRP vs. 321 controls). The application of PRP in TKA had a significantly less calculated total blood loss (MD = -98.11; 95% confidence interval [CI]: -153.63 to -42.59, P = .0005) and lower Hb drop (MD = -0.34; 95% CI: -0.59 to -0.09, P = .008) than the control in the early postoperative period while decreasing the LOS (MD = -2.12; 95% CI: -3.47 to -0.76, P = .002). No significant differences were seen in drain volume, Hb level, transfusion rate, ROM, WOMAC scores, and complications between the 2 groups (P > .05). CONCLUSIONS Our meta-analysis suggests that PRP appears to be effective in reducing postoperative blood loss and lowering Hb drop without increasing the risks of postoperative complications after TKA. However, owing to the variation of included studies, no firm conclusions can be drawn.