The Prognostic Value of Thrombocytopenia in COVID-19 Patients; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine. 2020;8(1):e75
INTRODUCTION Multiple lines of evidence have attested that decreased numbers of platelets may serve as a surrogate marker for poor prognosis in a wide range of infectious diseases. Thus, to provide a well-conceptualized viewpoint demonstrating the prognostic value of thrombocytopenia in COVID-19, we performed a meta-analysis of pertinent literature. METHODS The keywords "platelet" OR "thrombocytopenia" AND "COVID-19" OR "coronavirus 2019" OR "2019-nCoV" OR "SARS-CoV-2" were searched in National Library of Medicine Medline/PubMed and Scopus between December 30, 2019, and May 9, 2020 in English without any restriction. The initial search results were first screened by title and abstract, and then full texts of relevant articles representing information on the platelet count (main outcome) with a clinically validated deﬁnition of COVID-19 severity were ﬁnally selected. To assess the existence of bias in the included studies, the funnel plot and egger plot along with egger tests were used. Also, the heterogeneity among the included studies was tested using the Chi-square test. RESULTS The results of our meta-analysis of 19 studies, totaling 3383 COVID-19 patients with 744 (21.9%) severe cases, revealed that non-severe cases have a significantly higher number of platelets and showed that the probability of the emergence of thrombocytopenia is significantly higher in the severe cases with the pooled mean difference of -21.5 (%95 CI: -31.57, -11.43). CONCLUSION Decreased number of platelets more commonly associates with severe COVID-19; however, whether the emergence of thrombocytopenia may result in diseases severity or the severity of the disease may decrease platelets, is open to debate.
Elevation of d-dimer, but not pt and aptt, reflects the progression of covid-19 toward an unfavorable outcome: A meta-analysis
Iranian Journal of Blood and Cancer. 2020
Background: Coronavirus disease 2019 (abbreviated as COVID-19) is a mysterious respiratory syndrome symptomatically spanning from healthy carriers to patients with life-threatening complications, in some cases, leading to a mournful death For the time being, the contributory role of hematologists is much more recognized in the management of COVID-19, since the emergence of coagulopathy has recently been the focus of many studies in SARS-CoV-2 infection Methods: To provide a well-conceptualized viewpoint demonstrating the prognostic value of coagulation-related laboratory tests, we planned to perform a meta-analysis of pertinent literature representing information on PT, aPTT, and D-dimer tests in patients with COVID-19 Results: Albeit the estimated pooled means of PT and aPTT were higher in severe cases, their mean values were not significantly higher as compared with patients in a non-severe condition On the other hand, the mean value of D-dimer in severe patients was significantly higher than non-severe cases (X2=6 34, P=0 01), highlighting that the elevation of this parameter may be associated with the progression of the disease toward an unfavorable clinical outcome Conclusion: Even though at the time of writing this article the lack of adequate and appropriate studies denotes a major limitation to the current study, planning for the future research to determine the prognostic value of laboratory tests reflecting SARS-CoV-2-induced coagulopathy, mainly D-dimer, will definitively cast a flash of light on the significance of therapeutic anticoagulation at least for those with no absolute contraindication
Comparative evaluation of the safety and efficacy of recombinant FVIII in severe hemophilia A patients
Journal of Pharmacopuncture.. 2018;21((2)):76-81.
Objective: This study compared the safety and efficacy of Safacto versus xyntha in patients with severe hemophilia A. Methods: Thirty-three male patients with severe hemophilia A were randomly divided into two groups. Seventeen patients received Safacto and 16 patients received Xyntha for four consecutive times. The dosage of FVIII was 40-50 IU/kg for each injection. Plasma level of FVIII activity was evaluated before every injection, 15 minutes after the injection and one month after the start of the trial. The rate of factor VIII activity, pain and joint motion were also assessed before and after the treatment. Results: Plasma level of FVIII clotting activity in Safacto and Xyntha were 1.96+/-0.5 IU/dl and 1.63+/-0.5 IU/dl and increased to 88.84+/-25.2 IU/dl and 100.09+/-17.8 IU/dl, respectively (P<0.001). Pain score and range of motion improvement were 9.3+/-0.9 and 8.7+/-0.1 in Safacto (P=0.17); and 9.4+/-0.8 and 8.8+/-0.3 in Xyntha (P=0.35), respectively. No allergic or other unfavorable reactions was observed with either of the preparations. Conclusion: This study showed that Safacto has a favorable efficacy and safety profile.
A comparison of efficacy between recombinant activated factor VII (Aryoseven) and Novoseven in patients with hereditary FVIII deficiency with inhibitor
Clinical & Applied Thrombosis/Hemostasis. 2016;22((2)):184-90.
INTRODUCTION This study compared the efficacy of Aryoseven with Novoseven to control bleeding episodes in patients with hemophilia A with inhibitors. METHODS Sixty-six patients were randomized into 2 groups, with 4 consecutive block randomization. These groups received Aryoseven and Novoseven dosages of 90 to 120 mug/kg intravenously every 2 hours. RESULTS Median (interquartile range) level of factor VIII (FVIII) inhibitor in groups A and B was 15.0 and 19.0 Bethesda Unit (BU) preadministration. Bleeding onset in group A was 1246 +/- 1104 minutes and in group B was 2301 +/- 1693 minutes (P = .311). The Kavakli global response scores and treatment success rate was comparable in both the groups. The side effects in groups A (9.7%) and B (2.9%) were comparable. CONCLUSION Biosimilar recombinant activated FVII is found to be as effective as Novoseven in the treatment of acute joint bleeding in patients with hemophilia with inhibitors. Its usage will decrease the gaps in hemophilia.Copyright © The Author(s) 2014.
A Comparison Between Recombinant Activated Factor VII (Aryoseven) and Novoseven in Patients With Congenital Factor VII Deficiency
Clinical & Applied Thrombosis/Hemostasis. 2015;21((8)):724-8.
In order to establish the efficacy and biosimilar nature of AryoSeven to NovoSeven in the treatment of congenital factor VII (FVII) deficiency, patients received either agent at 30 mug/kg, intravenously per week for 4 weeks, in a randomized fashion. The primary aim was to compare FVIIcoagulation activity (FVII:C), 20 minutes after recombinant activated FVII (rFVIIa) injection, in the 2 groups. A secondary measure was self-reported bleeding. The median interquartile baseline range of the plasma level of activated FVII (FVIIa) activity in the 2 groups was 1.6 (1.1-14.0) IU/dL and 5.0 (1.1-25.5) IU/dL. All patients achieved levels of FVIIa (FVII:C) >30 IU/dL, 20 minutes after the injection of rFVIIa. Bleeding was similar between the 2 groups, with a comparable decrease in severity and frequency compared to the last month prior to treatment. AryoSeven is similar to NovoSeven in increasing postinjection FVIIa activity as well as in clinical safety and efficacy. Copyright © The Author(s) 2014.
Autologous fibrin sealant in tubeless percutaneous nephrolithotomy; a prospective study
Urology Journal. 2013;10((3):):999-1003.
Purpose: To evaluate the efficacy of autologous single-donor fibrin glue after tubeless percutaneous nephrolithotomy (PCNL).Materials and Methods: Forty-three patients were planned for tubeless PCNL in a prospective cohort study and randomized in two groups with or without using fibrin glue. Randomization method was based on the computer-generated random numbers.Results: Transfusion, urinary leakage, or major complications were found in neither of thegroups. There was no difference between two groups in stone free rate (P = .53), and changes in hemoglobin (P = .61) and serum creatinine (P = .63) level. Conclusion: Although autologous fibrin glue did not play any significant role in improving results or decreasing complications after tubeless PCNL in our study, its use was safe and did not increase complications.