1.
Efficacy and Economic Evaluation of Nonbiological Artificial Liver Therapy in Acute-on-chronic Hepatitis B Liver Failure
Wu C, Peng W, Cheng D, Gu H, Liu F, Peng S, Fu L
Journal of clinical and translational hepatology. 2023;11(2):433-440
Abstract
BACKGROUND AND AIMS Nonbiological artificial liver (NBAL) is frequently used as a first-line treatment for hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). This study aimed to compare the therapeutic efficacy and cost-effectiveness ratio (CER) of comprehensive medical treatment, plasma exchange (PE), and double plasma molecular adsorption system (DPMAS) plus half-dose PE (DPMAS+PE) in patients with HBV-ACLF. METHODS A total of 186 patients with HBV-ACLF randomly received comprehensive medical treatment, PE, or DPMAS+PE and were prospectively evaluated. Patients were divided into four subgroups based on the pretreatment prothrombin activity (PTA): Group I (PTA>40%), group II (PTA 30-40%), group III (PTA 20-30%), and group IV (PTA<20%). The main outcome measures were 28 day effectiveness; 90 day liver transplantation-free survival; change of biochemical parameters; and CER. RESULTS DPMAS+PE treatment was associated with significantly higher 28 day effectiveness and 90 day liver transplantation-free survival compared with PE treatment in patients with group I liver failure. Clearance of serum total bilirubin (TBIL), AST, and creatinine (Cr) were significantly higher in the DPMAS+PE group than in the PE group. For subjects with group I liver failure, DPMAS+PE treatment had advantages of lower CER values and better cost-effectiveness. CONCLUSIONS Compared with comprehensive medical treatment and PE alone, DPMAS with half-dose sequential PE treatment more effectively improved TBIL, AST, and Cr in HBV-ACLF patients, improved 28 day effectiveness and 90 day survival rates in patients with group I liver failure, and was more cost effective. DPMAS+PE is a viable NBAL approach for treatment of HBV-ACLF.
2.
Oral vs intravenous tranexamic acid in total-knee arthroplasty and total hip arthroplasty: A systematic review and meta-analysis
Chen X, Zheng F, Zheng Z, Wu X, Wu C
Medicine. 2019;98(20):e15248
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of oral tranexamic acid (TXA) with intravenous (IV) TXA in reducing perioperative blood loss in total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). METHODS PubMed, Web of Science, Embase, and Cochrane Library were fully searched for relevant studies. Studies comparing the efficacy and safety of oral TXA with IV TXA in TKA and THA were included in this research. Odds ratio (OR) or risk difference (RD) was applied to compare dichotomous variables, while mean difference (MD) was used to compare continues variables. RESULTS A total of 7 studies (5 randomized controlled trials and 2 retrospective studies) were included into this study. As for patients undergoing TKA or THA, there were no obvious differences between oral TXA group and IV TXA group in hemoglobin (Hb) drop (MD = 0.06, 95% confidence interval [CI] = -0.01 to 0.13, P = .09), transfusion rate (OR = 0.78, 95% CI = 0.54-1.13, P = .19), total blood loss (MD = 16.31, 95% CI = -69.85 to 102.46, P = .71), total Hb loss (MD = 5.18, 95% CI = -12.65 to 23.02, P = .57), length of hospital stay (MD = -0.06, 95% CI = -0.30 to 0.18, P = .63), drain out (MD = 21.04, 95% CI = -15.81 to 57.88, P = .26), incidence of deep vein deep vein thrombosis (RD = 0.00, 95% CI = -0.01 to 0.01, P = .82) or pulmonary embolism (RD = 0.00, 95% CI = -0.01 to 0.01, P = .91). The sample size of this study was small and several included studies were with relatively low quality. CONCLUSION Oral TXA is equivalent to IV TXA in reducing perioperative blood loss and should be recommended in TKA and THA. More high-quality studies are needed to elucidate this issue.