Diagnostic accuracy of dual-energy computed tomography to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke: systematic review and meta-analysis
European radiology. 2021
OBJECTIVES To assess whether dual-energy computed tomography (DECT), using conventional computed tomography or magnetic resonance imaging as a reference standard, is sufficiently accurate to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. METHODS On January 20, 2021, we searched the PubMed Medline, Embase, Web of Science, and Cochrane Library databases. QUADAS-2 was used to assess the risk of bias and applicability. Meta-analyses were performed using a bivariate random-effects model. To explore sources of heterogeneity, meta-regression analyses were performed. Deeks' funnel plot asymmetry test was used to assess publication bias. RESULTS A total of 7 studies (269 patients, 269 focal areas) were included. The pooled mean sensitivity, specificity, and accuracy of DECT in identifying intracerebral hemorrhage from contrast extravasation after mechanical thrombectomy for acute ischemic stroke were 0.77 (95% confidence interval (CI) 0.29 to 0.96), 1 (95% CI 0.86 to 1), and 0.99 (95% CI 0.98 to 1), respectively. This evidence was of moderate certainty due to the risk of bias. Higgin's I-squared for study heterogeneity was observed for the pooled sensitivity (I(2) = 78.88%) and pooled specificity (I(2) = 82.12%). Moreover, Deeks' funnel plot asymmetry test revealed no publication bias (p = 0.38). CONCLUSION DECT shows excellent accuracy and specificity in differentiating intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. Nevertheless, there was substantial and moderate heterogeneity among the studies. Future large-scale, prospective cohort studies are warranted to validate our findings. KEY POINTS • Dual-energy computed tomography shows excellent accuracy and specificity in differentiating intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke. • Via meta-regression analysis, we found various possible covariates, including the publication date, image analysis, index test time, time of follow-up imaging, and reference standard judgment, that had an important effect on the heterogeneity. • There were no concerns regarding applicability in any of the included studies.
COVID-19 and Coagulation Dysfunction in Adults: A Systematic Review and Meta-analysis
Journal of Medical Virology. 2020
BACKGROUND The outbreak of 2019 novel coronavirus disease (COVID-19) has posed a grave threat to the global public health. The COVID-19-induced infection is closely related to coagulation dysfunction in the affected patients. This paper attempts to conduct a meta-analysis and systematically review the blood coagulation indicators in severe COVID-19 patients. METHODS A meta-analysis of eligible studies was performed to compare the blood coagulation indicators in severe and non-severe COVID-19 patients. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies published between December 1, 2019 and May 7, 2020. RESULTS A total of 13 studies with 1,341 adult patients were enrolled in this analysis. Platelet [WMD=-24.83, 95% CI (-34.12, -15.54), p<0.001], d-dimer [WMD=0.19, 95% CI (0.09, 0.29), p<0.001] and fibrinogen [WMD=1.02, 95% CI (0.50, 1.54), p<0.001] were significantly associated with the severity in COVID-19 patients. The meta-analysis revealed that no correlation was evident between an increased severity risk of COVID-19 and activated partial thromboplastin time (APTT) [WMD=-1.56, 95% CI (-5.77, 2.64), p=0.468] or prothrombin time (PT) [WMD=0.19, 95% CI (-0.13, 0.51), p=0.243]. The single arm meta-analysis showed that, compared with the non-severe group, the severe group had a lower pooled platelet [165.12 (95% CI: 157.38-172.85) vs. 190.09 (95% CI: 179.45-200.74)], higher d-dimer [0.49 (95% CI: 0.33-0.64) vs. 0.27 (95% CI: 0.20-0.34)] and higher fibrinogen [4.34 (95% CI: 1.98-6.70) vs. 3.19 (95% CI: 1.13-5.24)]. CONCLUSIONS Coagulation dysfunction is closely related to the severity of COVID-19 patients, in which low platelet, high d-dimer and fibrinogen upon admission may serve as risk indicators for increased aggression of the disease. These findings are of great clinical value for timely and effective treatment of the COVID-19 cases. This article is protected by copyright. All rights reserved.
Umbilical cord milking reduces need for red cell transfusions and improves neonatal adaptation in preterm infants: meta-analysis
Journal of Obstetrics & Gynaecology Research. 2015;41((6)):890-5.
AIM: To assess effects of umbilical cord milking (UCM) on early blood pressure stabilization, hemoglobin (Hb), as well as incidence of transfusion and complications in preterm infants. METHODS This meta-analysis was conducted by searching the Pubmed, EMBASE and Cochrane Library (until July 2014) databases. Any clinical trials, including randomized control trials, comparing UCM to immediate cord clamping (ICC) were analyzed. RESULTS Six studies were included in this meta-analysis. In total, 292 preterm infants were treated with UCM, while 295 received ICC. Compared to ICC, UCM increased initial Hb significantly by 1.84g/dL (weighted mean difference; 95%CI: 0.91-2.76; P<0.0001) and decreased the incidence of transfusion with a pooled risk ratio of 0.74 (95%CI: 0.61-0.90; P=0.002). Incidence of necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) and mortality were significantly lower with UCM compared with ICC. Apgar score and temperature were not significantly different between the two groups. CONCLUSIONS By facilitating the early stabilization of blood pressure, UCM at preterm birth was found to be comparatively safe and associated with lower blood transfusion exposure and lower incidence of IVH, NEC and death.Copyright © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.
Comparison of two tranexamic acid dose regimens in patients undergoing cardiac valve surgery
Journal of Cardiothoracic & Vascular Anesthesia. 2014;28((5):):1233-7.
OBJECTIVE Tranexamic acid (TA), a synthetic antifibrinolytic drug, has been shown to reduce postoperative bleeding and the need for allogeneic blood transfusion in cardiac surgery. However, the optimal dose regimen of TA is still under debate. The aim of this study was to evaluate whether a lower-dose TA regimen produced equivalent efficacy to its higher-dose counterpart in reducing postoperative bleeding and transfusion needs. DESIGN A prospective, randomized, double-blind trial. SETTING National Center for Cardiovascular Diseases & University Hospital, Beijing, People's Republic of China. PARTICIPANTS One hundred seventy-five patients undergoing cardiac valve surgery were enrolled in the study. INTERVENTIONS All patients were divided randomly into 2 groups. The lower-dose TA group received a loading dose of 10 mg/kg, maintenance dose of 2 mg/kg/h, and a cardiopulmonary bypass pump prime dose of 40 mg; the higher-dose TA group received a loading dose of 30 mg/kg, maintenance dose of 16 mg/kg/h, and a pump prime dose of 2 mg/kg. MEASUREMENTS AND MAIN RESULTS The amount of postoperative bleeding, the amount and frequency of allogeneic transfusion, mortality, and morbidities were recorded. There was no significant difference in the volume of 24-hour postoperative bleeding between the lower-dose group and the higher-dose group. Other measurements also showed no statistical difference between the 2 groups, including the amount and frequency of allogeneic transfusion, mortality, and morbidities. CONCLUSION Lower-dose TA regimen was as effective as the higher-dose regimen in reducing postoperative bleeding and transfusion needs in patients undergoing cardiac valve surgery. 2014 Elsevier Inc. All rights reserved.