Science Conference Proceedings Research Articles

Anti-fibrinolytics for mucosal bleeding in adults with life-limiting illnesses: a systematic review

IntroductionPatients with life-limiting illnesses are at increased risk of mucosal bleeding. Usual management includes anticipatory planning and sedation, alongside anti-fibrinolytics, despite a lack of evidence for their use. Anti-fibrinolytic agents...

Efficacy and safety of immune checkpoint inhibitors for individuals with advanced EGFR-mutated non-small-cell lung cancer who progressed on EGFR tyrosine-kinase inhibitors: a systematic review, meta-analysis, and network meta-analysis

The clinical benefits of immune checkpoint inhibitor (ICI)-based treatments in treating individuals with advanced EGFR-mutated non-small-cell lung cancer (NSCLC) who have progressed on EGFR tyrosine-kinase inhibitors (TKIs) remain controversial. We aimed to review the literature to comprehensively investigate the individual and comparative clinical outcomes of various ICI-based treatment strategies in this population. In this systematic review and meta-analysis, we used single-arm, pairwise, and network meta-analytical approaches. We searched PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrials.gov, and relevant international conference proceedings from database inception to Jan 31, 2024, without language restrictions, to identify eligible clinical trials that assessed ICI-based treatments for individuals with advanced EGFR-mutated NSCLC who progressed on EGFR-TKIs. Studies considered eligible were published and unpublished phase 1, 2, or 3 clinical trials enrolling participants with histologically or cytologically confirmed advanced EGFR-mutated NSCLC who had progressed after at least one EGFR-TKI treatment, and that evaluated ICI-based treatment strategies on at least one of the clinical outcomes of interest. The primary outcome analysed was progression-free survival. The protocol is registered with PROSPERO, CRD42021292626. 17 single-arm trials and 15 randomised controlled trials, involving 2886 participants and seven ICI-based treatment strategies (ICI monotherapy, ICI plus chemotherapy [ICI-chemo], ICI plus antiangiogenesis [ICI-antiangio], ICI plus antiangiogenesis plus chemotherapy [ICI-antiangio-chemo], dual ICIs [ICI-ICI], dual ICIs plus chemotherapy [ICI-ICI-chemo], and ICI plus EGFR-TKI [ICI-TKI]), were included. Three of these strategies-ICI monotherapy, ICI-antiangio-chemo, and ICI-chemo-had sufficient data across the included studies to perform a pairwise meta-analysis. The pairwise meta-analysis showed that, compared with chemotherapy, ICI monotherapy led to shorter progression-free survival (hazard ratio [HR] 1·73 [95% CI 1·30-2·29], I2=0%), whereas ICI-antiangio-chemo (HR 0·54 [0·44-0·67], I2=0%) and ICI-chemo (HR 0·77 [0·67-0·88], I2=0%) prolonged progression-free survival. The network meta-analysis showed that ICI-antiangio-chemo yielded the best progression-free survival results, with substantial benefits over ICI-chemo (HR 0·71 [95% credible interval 0·59-0·85]), ICI monotherapy (HR 0·30 [0·22-0·41]), and non-ICI treatment strategies including antiangio-chemo (HR 0·76 [0·58-1·00]) and chemotherapy alone (HR 0·54 [0·45-0·64]). ICI-antiangio-chemo was associated with higher risks of both any-grade and grade 3 or worse adverse events over ICI-chemo and chemotherapy in the network meta-analysis. For individuals with advanced EGFR-mutated NSCLC who progressed on EGFR-TKIs, ICI-antiangio-chemo was identified as the optimal treatment option. The toxicity of this treatment was acceptable but needs careful attention. ICI-chemo showed appreciably greater efficacy than the standard-of-care chemotherapy. These findings clarified the roles of ICI-based treatment strategies in this difficult-to-treat refractory population, potentially complementing recent guidelines. None.

Efficacy of psilocybin for treating symptoms of depression: systematic review and meta-analysis

ObjectiveTo determine the efficacy of psilocybin as an antidepressant compared with placebo or non-psychoactive drugs.DesignSystematic review and meta-analysis.Data sourcesFive electronic databases of published literature (Cochrane Central Register of Controlled Trials,...

Epilepsy surgery in adults older than 50 years: A systematic review and meta-analysis.

Despite the general safety and efficacy of epilepsy surgery, there is evidence that epilepsy surgery remains underutilized. Although there are an increasing number of studies reporting epilepsy surgery in older adults, there is no consensus on whether epilepsy surgery is efficacious or safe for this population. Our objective was to systematically assess the efficacy as well as safety of resective surgery in people aged 50 years or older with drug-resistant epilepsy. We considered studies that examine the efficacy and safety of epilepsy surgery in adults aged 50 years and older. Study eligibility was limited to studies carried out after 1990, with a minimum of 10 participants and 6 months of follow-up. We searched the following databases for published studies: Ovid MEDLINE, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, and Web of Science Conference Proceedings Citation Index - Science. The risk of bias of each included study was independently assessed by two reviewers using the MINORS (Methodological Index for Non-Randomized Studies) instrument. Eleven case series and 14 cohort studies met the criteria for inclusion, for a total of 1111 older adults who underwent epilepsy surgery along with 4111 adults younger than 50 years as control groups. The pooled cumulative incidence of older adults achieving seizure freedom after resective surgery was 70.1% (95% confidence interval [CI] = 65.3-74.7). There was no evident difference in the incidence of seizure freedom among older adults as compared to younger adults (risk ratio [RR] = 1.05, 95% CI = .97-1.14) in cohort studies. The pooled cumulative incidence of perioperative complications in older adults was 26.2% (95% CI = 21.3-31.7). Among them, 7.5% (95% CI = 5.8-9.5) experienced major complications. Older adults were significantly more at risk of experiencing any complication than younger adults (RR = 2.8, 95% CI = 1.5-5.4). Despite important considerations, epilepsy surgery may be considered appropriate among carefully selected individuals older than 50 years.

Development of intelligent system of global bibliographic search

The paper presents scientifically grounded principles of formation and algorithms of a global bibliographic retrieval system based on modern intelligent technologies (intelligent linguistic analysis of texts and database management) and Internet search methods. Within the framework of theoretical bibliography, for the first time taking into account the specifics of modern intelligent software, a new algorithm of an integrated automated system for global bibliographic retrieval as well as search for specialized publications to publish research papers was developed. The developed methods include the formation of a normalized database of keywords based on the Universal Decimal Classification (UDC) categories and the automatic assignment of keywords from this normalized database to research papers by an intelligent system for linguistic analysis of texts. The proposed use of keywords as data labels in the form of UDC categories, covering all branches of knowledge, makes it possible to precisely label and describe research papers and scientific publications (journals, proceedings of scientific conferences) to the fullest extent possible. The search for research papers by the proposed bibliographic retrieval system as well as the search for specialized publications to publish those research papers is carried out automatically by normalized keywords assigned to research papers and scientific journals based on intelligent linguistic analysis of the content of those research papers. The study makes a social contribution and shows how it is important to create and utilize best practices, processes and strategies of bibliographic retrieval, which are essential in the development of science in modern society. Besides, in social terms, the search for bibliographic information is one of the methods to solve the problem of finding a relation between personal and public knowledge. The implementation of the study results in accordance with the presented algorithms consists in designing a special global public Internet search resource.

Amlodipine Therapy in β-Thalassemia Patients: A Systematic Review and Meta-Analysis on Ferritin Levels and Liver MRI T2*

Background and aim: We conducted a review to determine the efficacy of amlodipine alongside iron chelators on serum ferritin levels and liver T2-weighted magnetic resonance imaging (MRI T2*) in β-thalassemia patients. Methods: Systematic search was conducted in multiple databases, including Web of Science, PubMed, Scopus, Embase, Cochrane Library, ClinicalTrials.gov, the Iranian Registry of Clinical Trials (IRCT), ProQuest, OpenGrey, and Web of Science Conference Proceedings Citation Index. The search was closed in January 2023. Primary outcomes were comprised of liver MRI T2* (millisecond (msec)) and serum ferritin levels (ng/mL). Results: Seven studies (n = 227) were included in the study. The pooled Cohen’s d for serum ferritin was estimated at −0.46, 95% confidence interval (CI) −1.11 to 0.19 and p = 0.16 (I2 86.23%, p < 0.0001). The pooled mean difference for serum ferritin was −366.44 ng/mL, 95% CI −844.94 to 112.05, and p = 0.13 (I2 81.63%, p < 0.0001). After a meta-regression based on the length of using amlodipine, a coefficient for the mean difference was also −23.23 ng/mL and 95% CI −155.21 to 108.75. The coefficient obtained from a meta-regression as per the amlodipine dose at 5 mg/day than 2.5 to 5 mg/day anchored at −323.49 ng/mL and 95% CI −826.14 to 1473.12. A meta-regression according to the baseline values of serum ferritin discovered a coefficient of 1.25 ng/mL and 95% CI 0.15 to 2.35. Based on two included studies (n = 96), the overall Cohen’s d for liver MRI T2* was 2.069, 95% CI −0.896 to 5.035, and p = 0.17 (I2 96.31%, p< 0.0001). The synthesized mean difference for liver MRI T2* was 8.76 msec, 95% CI −4.16 to 21.67, and p = 0.18 (I2 98.38%, p < 0.000). Conclusion: At a very low level of evidence, probably using amlodipine at a dose of 2.5 to 5 mg a day, up to a year, alongside iron chelators slightly decreases serum ferritin levels in iron-overloaded thalassemia cases by nearly 366 ng/mL (23 ng/mL per month). The liver MRI T2* might also rise to 8.76 msec upon co-therapy with amlodipine.

Validity of the models predicting 10-year risk of cardiovascular diseases in Asia: A systematic review and prediction model meta-analysis.

We aimed to review the validity of existing prediction models for cardiovascular diseases (CVDs) in Asia. In this systematic review and meta-analysis, we included studies that validated prediction models for CVD risk in the general population in Asia. Various databases, including PubMed, Web of Science conference proceedings citation index, Scopus, Global Index Medicus of the World Health Organization (WHO), and Open Access Thesis and Dissertations (OATD), were searched up to November 2022. Additional studies were identified through reference lists and related reviews. The risk of bias was assessed using the PROBAST prediction model risk of bias assessment tool. Meta-analyses were performed using the random effects model, focusing on the C-statistic as a discrimination index and the observed-to-expected ratio (OE) as a calibration index. Out of 1315 initial records, 16 studies were included, with 21 external validations of six models in Asia. The validated models consisted of Framingham models, pooled cohort equations (PCEs), SCORE, Globorisk, and WHO models, combined with the results of the first four models. The pooled C-statistic for men ranged from 0.72 (95% CI 0.70 to 0.75; PCEs) to 0.76 (95% CI 0.74 to 0.78; Framingham general CVD). In women, it varied from 0.74 (95% CI 0.22 to 0.97; SCORE) to 0.79 (95% CI 0.74 to 0.83; Framingham general CVD). The pooled OE ratio for men ranged from 0.21 (95% CI 0.018 to 2.49; Framingham CHD) to 1.11 (95%CI 0.65 to 1.89; PCEs). In women, it varied from 0.28 (95%CI 0.33 to 2.33; Framingham CHD) to 1.81 (95% CI 0.90 to 3.64; PCEs). The Framingham, PCEs, and SCORE models exhibited acceptable discrimination but poor calibration in predicting the 10-year risk of CVDs in Asia. Recalibration and updates are necessary before implementing these models in the region.

Mapping the Evidence for Opioid-Mediated Changes in Malignancy and Chemotherapeutic Efficacy: Protocol for a Scoping Review.

Numerous reports contend opioids can augment or inhibit malignancy. At present, there is no consensus on the risk or benefit posed by opioids on malignancy or chemotherapeutic activity. Distinguishing the consequences of opioid use from pain and its management is challenging. Additionally, opioid concentration data is often lacking in clinical studies. A scoping review approach inclusive of preclinical and clinical data will improve our understanding of the risk-benefit relationship concerning commonly prescribed opioids and cancer and cancer treatment. The aim of the study is to map diverse studies spanning from preclinical to clinical regarding opioids with malignancy and its treatment. This scoping review will use the Arksey six stages framework to (1) identify the research question; (2) identify relevant studies; (3) select studies meeting criteria; (4) extract and chart data; (5) collate, summarize, and report results; and (6) conduct expert consultation. An initial pilot study was undertaken to (1) parameterize the extent and scale of existing data for an evidence review, (2) identify key factors to be extracted in systematic charting efforts, and (3) assess opioid concentration as a variable for its relevance to the central hypothesis. Six databases will be searched with no filters: MEDLINE, Embase, CINAHL Complete, Cochrane Library, Biological Sciences Collection, and International Pharmaceutical Abstracts. Trial registries will include ClinicalTrials.gov, Cochrane CENTRAL, International Standard Randomised Controlled Trial Number Registry, European Union Clinical Trials Register, and World Health Organization International Clinical Trials Registry. Eligibility criteria will include preclinical and clinical study data on opioids effects on tumor growth or survival, or alteration on the antineoplastic activity of chemotherapeutics. We will chart data on (1) opioid concentration from human subjects with cancer, yielding a "physiologic range" to better interpret available preclinical data; (2) patterns of opioid exposure with disease and treatment-related patient outcomes; and (3) the influence of opioids on cancer cell survival, as well as opioid-related changes to cancer cell susceptibility for chemotherapeutics. This scoping review will present results in narrative forms as well as with the use of tables and diagrams. Initiated in February 2021 at the University of Utah, this protocol is anticipated to generate a scoping review by August 2023. The results of the scoping review will be disseminated through scientific conference proceedings and presentations, stakeholder meetings, and by publication in a peer-reviewed journal. The findings of this scoping review will provide a comprehensive description of the consequences of prescription opioids on malignancy and its treatment. By incorporating preclinical and clinical data, this scoping review will invite novel comparisons across study types that could inform new basic, translational, and clinical studies regarding risks and benefits of opioid use among patients with cancer. PRR1-10.2196/38167.

Effect of renin-angiotensin-aldosterone system inhibitors on survival outcomes in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis.

Effect of renin-angiotensin-aldosterone system inhibitors (RAASIs) in combination with immune checkpoint inhibitors (ICIs) on prognoses in cancer patients remains controversial. This study systematically evaluated the effect of RAASIs on survival outcomes in cancer patients receiving ICIs treatment and provided an evidence-based reference for the rational use of RAASIs and ICIs combination therapy in clinical practice. Studies evaluating the prognosis of RAASIs-used versus RAASIs-free in cancer patients receiving ICIs treatment from inception to 1 November 2022 were retrieved by searching PubMed, Cochrane Library, Web of Science, Embase, and major conference proceedings. Studies in English reporting hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and/or progression-free survival (PFS) were included. Statistical analyses were conducted using the software Stata 17.0. A total of 12 studies containing 11739 patients were included, comprising ~4861 patients in the RAASIs-used and ICIs-treated group and ~6878 patients in RAASIs-free and ICIs-treated group. The pooled HR was 0.85 (95%CI, 0.75-0.96; P = 0.009) for OS and 0.91 (95%CI, 0.76-1.09; P = 0.296) for PFS, indicating a positive effect of RAASIs concomitant with ICIs on cancer patients. This effect was observed especially in patients with urothelial carcinoma (HR, 0.53; 95%CI, 0.31-0.89; P = 0.018) and renal cell carcinoma (HR, 0.56; 95%CI, 0.37-0.84; P = 0.005) on OS. Concomitant use of RAASIs and ICIs enhanced the efficacy of ICIs and this combination regimen was associated with significantly improved OS and a trend towards better PFS. RAASIs can be considered as adjuvant drugs when hypertensive patients receive ICIs treatment. Our results provide an evidence-based reference for the rational use of the RAASIs and ICIs combination therapy to improve the efficacy of ICIs in clinical practice. https://www.crd.york.ac.uk/prospero/, identifier CRD42022372636; https://inplasy.com/, identifier INPLASY2022110136.

Building an understanding of Ethnic minority people’s Service Use Relating to Emergency care for injuries: the BE SURE study protocol

IntroductionInjuries are a major public health problem which can lead to disability or death. However, little is known about the incidence, presentation, management and outcomes of emergency care for patients...

Interventions for improving adherence to iron chelation therapy in people with sickle cell disease or thalassaemia.

Interventions for improving adherence to iron chelation therapy in people with sickle cell disease or thalassaemia.

Efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases: A systematic review and meta-analysis.

Aerobic exercise aims to improve aerobic capacity. To summarize the evidence on the efficacy of aerobic exercise on aerobic capacity in slowly progressive neuromuscular diseases (NMDs). We searched the electronic databases MEDLINE, EMBASE, SPORTDiscus and Web of Science Conference Proceedings Index for articles published up to June 17, 2021, selecting randomized controlled trials that included adults with slowly progressive NMDs and compared aerobic exercise to no aerobic exercise. The primary outcome was peak oxygen uptake (VO2peak) directly post-intervention. Secondary outcomes included other peak test parameters, submaximal test parameters, long-term outcomes ≥8 weeks post-intervention, adherence and adverse events. Meta-analyses were performed for the primary outcome and for secondary outcomes when reported in more than 2 studies. Risk of bias was assessed with the Cochrane Risk of Bias tool and quality of evidence according to GRADE. Nine studies were included (195 participants with 8 different NMDs). Eight studies were rated at high risk of bias and 1 study was rated at some concerns. Duration of exercise programs ranged from 6 to 26 weeks, with 3 weekly training sessions of 20 to 40min, based on maximal capacity. Meta-analyses revealed short-term moderate beneficial effects of aerobic exercise on VO2peak (standardized mean difference [SMD] 0.55, 95% CI 0.23; 0.86) and peak workload (SMD 0.61, 95% CI 0.24; 0.99). Long-term effects were not assessed. Most training sessions (83-97%) were completed, but time spent in target intensity zones was not reported. Included studies lacked detailed adverse event reporting. There is low-quality evidence that aerobic exercise is safe and leads to moderate improvement of aerobic capacity directly post-intervention in slowly progressive NMDs, but the long-term efficacy remains unclear. Detailed information about the time spent in target intensity zones and adverse events is lacking. CRD42020200083.

Access to medicine among asylum seekers, refugees and undocumented migrants across the migratory cycle: a scoping review protocol

IntroductionMigration creates new health vulnerabilities and exacerbates pre-existing medical conditions. Migrants often face legal, system-related, administrative, language and financial barriers to healthcare, but little is known about factors that specifically...

Editorial

Welcome to the inaugural issue of the African Journal of Science Technology and Social Sciences: a peer-reviewed, multidisciplinary journal in the field of Science, Technology and Social sciences. Launched by Meru University of Science and Technology, AJSTSS provides a cross-disciplinary and international forum for researchers to disseminate innovative research and practices that preserve the integrity, life-cycle performance, and resilience of new or existing knowledge. The many challenges towards achieving improved publications must be addressed with proactive, holistic, and multidisciplinary approaches. This journal is facilitating an in-depth dialogue and synergistic collaboration between both the academia and industry. We aspire to establish AJSTSS as the flagship journal in the various emerging fields with a focus on creating consistent contributions. All abstracts and manuscripts have gone through a rigorous yet relatively rapid peer-review process, which translates to benefits such as timeliness of publication, widespread dissemination, high visibility, and likelihood of high citations and broader impacts. We are presenting cutting-edge innovations and the latest insights and strive to maintain quality. AJSTSS provides the most complete and reliable source of information on current developments in the field and facilitate peer-to-peer exchange and dialogue beyond the conventional discipline boundaries, leading towards proactive and systematic solutions that enhance reliability. The emphasis is on publishing high-quality articles, including original research papers, research notes, and reviews - all of which contribute to advancing the knowledge base of infrastructure preservation and resilience and bridging the gaps between different disciplines and stakeholders relevant to the development and implementation of best solutions. In this first issue we have published abstracts from the Inaugural Meru University of Science and Technology International Conference Proceedings (MUSTIC 2022). Welcome! From the Editor in ChiefProf. Eric Muchiri (Ph.D.)

Analysis of the market of mine support systems in Russia

The analytical results on the current condition and growth prospects of the market of mine support systems in Russia are presented. The scope of the analysis involved all available and open sources of information: databases of the Federal Customs Service and of the Federal Service for State Statistics of the Russian Federation; regulatory documents in open access; printed and electronic business materials and analytical reviews; global Internet; expert inquiries; information provided by the participants of the domestic and international markets; research data of marketing and consulting agencies; databases of sectoral institutions; pricing monitoring results; research papers and proceedings of scientific conferences. The present-day business climate in the mining industry in Russia is assessed. The major importers of mine support systems and the average price dynamics of the relevant imports for the last 5 years are identified. The vulnerable spots are detected on the Russian market, namely, the lack of the pre-feasibility study procedures of new, innovative and expensive systems and types of mine support; the lack of testing machines to estimate and demonstrate operation of different mine support systems and types under static and dynamic loading with a view to determining their energy absorption capacity and deformation characteristics, etc. The mineral resources and mineral reserves of Russia are evaluated per regions of the country. The information on production of mine support systems in Russia is given together with the review and characteristic of the suppliers, as well as with the procedure and sequence of mine support system certification in Russia. The manufacturers of sheet and rolled products, metal (forged) female screws, special structural iron and H-beams are listed. Based on the analytical results on the market of mine support systems in Russia, at the current stage of development of the mining industry, the Russian manufacturers and suppliers of mine support systems have good prospects for the effective internal marketing of the products and for engineering of innovative systems and materials. These prospects are for the first turn connected with: the ability to completely supply production with domestic rolled products, structural iron and other required materials; the elimination of imports of such products from unfriendly countries; the stiffening of the government supervision over safety in mining; and with the concern of the scientific community in Russia for engineering and design of novel and nonstandard mine support systems for different geological and geotechnical conditions. The 2021 Report on the Market of Mine Support Systems in Russia and Kazakhstan includes a substantial volume of statistical data on all essential areas and topics. The report is available on request at the Research Center for Applied Geomechanics and Convergent Technologies in Mining of the NUST MISIS’ College of Mining.

Measurement Properties of Aerobic Capacity Measures in Neuromuscular Diseases: A Systematic Review.

ObjectiveTo systematically evaluate the measurement properties of aerobic capacity measures in neuromuscular diseases.Data sourcesMEDLINE, EMBASE, SportDiscus and Web of Science Conference Proceedings Citation Index – Science were systematically searched from inception until 30 June 2021.Study selection and data extractionScreening, data extraction, risk of bias assessment and quality assessment were performed by 2 independent researchers. Studies were included if they evaluated measurement properties of aerobic capacity measures in adults with neuromuscular diseases. Risk of bias was assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Results were pooled and the quality of the evidence was determined using a modified Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.Data synthesisNine studies including 187 participants were included in this review. Low quality of evidence was found for sufficient content validity of peak oxygen consumption through maximal exercise testing. Criterion validity of 4 out of 7 different measures to predict peak oxygen consumption was sufficient; however, quality of evidence was low or very low for all measures. No studies were found evaluating reliability or responsiveness.ConclusionThere was a lack of high-quality studies with sufficiently large sample sizes that evaluated the measurement properties of aerobic capacity measures in neuromuscular diseases.LAY ABSTRACTAerobic capacity (or cardiovascular endurance) is an important outcome measure in exercise intervention studies and pharmacological trials in neuromuscular diseases. To establish the effects of these interventions it is important to use outcome measures with good measurement properties. This means that outcome measures are accurate (valid), repeatable (reliable) and able to detect change over time (responsive). The aim of this study was to review the scientific literature regarding the measurement properties of aerobic capacity measures in neuromuscular diseases. Nine small studies (4–44 participants) reporting on the validity of 8 aerobic capacity measures were found. Five of these measures were judged as valid, but the quality of evidence was low. There were no studies evaluating reliability and responsiveness. Taken together, these results were considered insufficient to make recommendations. High-quality studies, with more participants and a focus on reliability and responsiveness, are required.

Aluminium adjuvants versus placebo or no intervention in vaccine randomised clinical trials: a systematic review with meta-analysis and Trial Sequential Analysis

ObjectivesTo assess the benefits and harms of aluminium adjuvants versus placebo or no intervention in randomised clinical trials in relation to human vaccine development.DesignSystematic review with meta-analysis and trial sequential...

Factors that influence clinical trial participation by patients with cancer in Australia: a scoping review protocol

IntroductionClinical trials are the backbone of research. It is well recognised that patient participation in clinical trials can be influenced by a myriad of factors such as access to a...

Transfusion thresholds for guiding red blood cell transfusion.

Transfusion thresholds for guiding red blood cell transfusion.

Randomized trials of therapeutic heparin for COVID‐19: A meta‐analysis

BackgroundPulmonary endothelial injury and microcirculatory thromboses likely contribute to hypoxemic respiratory failure, the most common cause of death, in patients with COVID‐19. Randomized controlled trials (RCTs) suggest differences in the effect of therapeutic heparin between moderately and severely ill patients with COVID‐19. We did a systematic review and meta‐analysis of RCTs to determine the effects of therapeutic heparin in hospitalized patients with COVID‐19. MethodsWe searched PubMed, Embase, Web of Science, medRxiv, and medical conference proceedings for RCTs comparing therapeutic heparin with usual care, excluding trials that used oral anticoagulation or intermediate doses of heparin in the experimental arm. Mantel‐Haenszel fixed‐effect meta‐analysis was used to combine odds ratios (ORs). Results and ConclusionsThere were 3 RCTs that compared therapeutic heparin to lower doses of heparin in 2854 moderately ill ward patients, and 3 RCTs in 1191 severely ill patients receiving critical care. In moderately ill patients, there was a nonsignificant reduction in all‐cause death (OR, 0.76; 95% CI, 0.57‐1.02), but significant reductions in the composite of death or invasive mechanical ventilation (OR, 0.77; 95% CI, 0.60 0.98), and death or any thrombotic event (OR, 0.58; 95% CI, 0.45‐0.77). Organ support‐free days alive (OR, 1.29; 95% CI, 1.07‐1.57) were significantly increased with therapeutic heparin. There was a nonsignificant increase in major bleeding. In severely ill patients, there was no evidence for benefit of therapeutic heparin, with significant treatment‐by‐subgroup interactions with illness severity for all‐cause death (P= .034). In conclusion, therapeutic heparin is beneficial in moderately ill patients but not in severely ill patients hospitalized with COVID‐19.