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Osman M, Farjo PD, Osman K, Radaideh Q, Munir MB, Kheiri B, Balla S. The dawn of aspirin free strategy after short term dual antiplatelet for percutaneous coronary intervention: meta-analysis of randomized controlled trials. J Thromb Thrombolysis 2020; 49:184-191. [PMID: 31749123 DOI: 10.1007/s11239-019-01997-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is still a debate about the safety and efficacy of an aspirin free strategy after percutaneous coronary intervention (PCI). Hence, we performed a meta-analysis comparing aspirin free strategy to dual antiplatlets therapy (DAPT). Randomized trials (RCTs) comparing aspirin free strategy to DAPT in patients who received PCI were included. The primary outcome of interest was bleeding, defined per the Bleeding Academic Research Consortium (BARC). Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACE); defined as all-cause mortality, myocardial infarction or stroke, the individual component of MACE and stent thrombosis. A total of 4 RCTs with 29,089 patients were included. There was significant reduction in BARC 2,3 or 5 bleeding events in patients who were treated with aspirin free strategy versus DAPT (HR 0.61, 95% CI 0.39-, p = 0.03, I2 = 89%). Moreover, although there was a trend of reduced major bleeding (BARC 3 or 5) outcomes in the aspirin free strategy group compared to the DAPT group, this did not achieve statistical significance (HR 0.63, 95% CI 0.37-1.06, p = 0.08, I2 = 795). Additionally, there was no difference between the aspirin free strategy and DAPT in term of MACE (HR 0.92, 95% CI 0.82-1.03, p = 0.13, I2 = 0%), all-cause mortality (HR 0.89, 95% CI 0.77-1.04, p = 0.15, I2 = 0%), MI (HR 0.89, 95% CI 0.74-1.08, p = 0.24, I2 = 0%), stroke (HR 1.13, 95% CI 0.65-1.99, p = 0.66, I2 = 60%) or stent thrombosis (HR 0.1.01, 95% CI 0.83-1.22, p = 0.93, I2 = 0%). Aspirin free strategy is as effective as DAPT in reducing MACE with better safety profile in term of bleeding.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Peter D Farjo
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Khansa Osman
- Michigan Health Specialists, Michigan State University, Flint, MI, USA
| | - Qais Radaideh
- Midwest Cardiovascular Research Foundation, Davenport, IA, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
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Kumar K, Kheiri B, Simpson TF, Osman M, Rahmouni H. Sodium-Glucose Cotransporter-2 Inhibitors in Heart Failure: A Meta-Analysis of Randomized Clinical Trials. Am J Med 2020; 133:e625-e630. [PMID: 32389659 DOI: 10.1016/j.amjmed.2020.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to conduct this study with the goal of further clarifying the role of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with preexisting heart failure with reduced ejection fraction with or without diabetes and to leverage increased sample size and power to evaluate clinically important secondary safety and efficacy outcomes. METHODS This meta-analysis was completed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was a composite of cardiovascular death or heart failure hospitalization. Secondary outcomes included the individual components of the primary outcome; major adverse cardiovascular events (defined as a composite of cardiovascular death, myocardial infarction, stroke), any death, myocardial infarction, or stroke, along with adverse events such as volume depletion, acute kidney injury, adverse events leading to drug discontinuation, amputation, and severe hypoglycemia. Other outcomes included the Kansas City Cardiomyopathy Questionnaire (KCCQ) total symptom score and changes in N-terminal pro-hormone BNP (NT-proBNP). Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for dichotomous variables and weighted difference (MD) and 95% CI for continuous variables. RESULTS Compared with placebo, SGLT2i use was associated with a significant reduction of cardiovascular death or heart failure hospitalization (HR = 0.74; 95% CI = 0.66-0.82; P <0.01), heart failure hospitalization (HR = 0.69; 95% CI = 0.57-0.84; P <0.01), cardiovascular death (HR = 0.79; 95% CI = 0.68-0.92; P <0.01), and any death (HR = 0.80; 95% CI = 0.70-0.92; P <0.01). CONCLUSIONS SGLT2i was associated with a decreased risk of clinically relevant cardiovascular death, heart failure hospitalization, and heart failure symptoms with similar rates of adverse events.
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Affiliation(s)
- Kris Kumar
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Timothy F Simpson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, W Va
| | - Hind Rahmouni
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Ore.
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Osman M, Syed M, Abdul Ghaffar Y, Patel B, Abugroun A, Kheiri B, Kawsara A, Kadiyala M, Balla S, Daggubati R. Gender-based outcomes of impeller pumps percutaneous ventricular assist devices. Catheter Cardiovasc Interv 2020; 97:E627-E635. [PMID: 33058477 DOI: 10.1002/ccd.29222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is paucity of data focusing on females' outcomes after the use of impeller pumps percutaneous ventricular assist devices (IPVADs). METHODS Patients who received IPVADs during the period of October 1st, 2015-December 31, 2017, were identified from the United States National Readmission Database. A 1:1 propensity score matching was used to compare the outcomes between females and males. RESULTS A total of 19,278 (Female = 5,456; Male = 13,822) patients were included in the current analysis. After propensity score matching and among all-comers who were treated with IPVADs, females had higher in-hospital major adverse events (MAEs) (38 vs. 32.6%, p < .01), mortality (31 vs. 28%, p < .01), vascular complications (3.3 vs. 2.1%, p < .01), major bleeding (7.8 vs. 4.8%, p < .01), nonhome discharges (21.6 vs. 16.3%; p < .01), and longer length of stay (7 days [IQR 2-12] vs. 6 days [IQR 2-12], p = .02) with higher 30-day readmission rate compared to males (20.5 vs.16.4%, p < .01). Furthermore, among patients who received the IPVADs for high-risk percutaneous coronary intervention (HRPCI), females continued to have worse MAEs, which was driven by high rates of major bleeding. However, among patients who received IPVADs for cardiogenic shock (CS) the outcomes of females and males were comparable. CONCLUSIONS Among all-comers who received IPVADs, females suffered higher morbidity and mortality compared to males. Higher morbidity driven mainly by higher rates of major bleeding was seen among females who received IPVADs for the hemodynamic support during HRPCI and comparable outcomes were observed when the IPVADs were used for CS.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Moinuddin Syed
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Yasir Abdul Ghaffar
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ashraf Abugroun
- Department of Internal medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Madhavi Kadiyala
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Radaideh Q, Osman M, Kheiri B, Al-Abdouh A, Barbarawi M, Bachuwa G, Tamis-Holland JE, Shammas NW, Boden WE. Meta-Analysis of the Effect of Percutaneous Coronary Intervention on Death and Myocardial Infarction in Patients With Stable Coronary Artery Disease and Inducible Myocardial Ischemia. Am J Cardiol 2020; 133:171-174. [PMID: 32838929 DOI: 10.1016/j.amjcard.2020.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND There has been a continuous debate about the survival benefit of percutaneous coronary intervention (PCI) for the management of patients with stable ischemic heart disease (SIHD) and moderate to severe ischemia. In this study we aimed to summarize the currently available evidence from randomized controlled trials (RCTs) on PCI versus medical therapy (MT) for patients with SIHD. METHODS An electronic database search was conducted for RCTs that compared PCI on top of MT versus MT alone. A random effects model was used to calculate relative risk (RR) and 95% confidence intervals (CIs). RESULTS A total of 7 RCTs with 10,043 patients with a mean age of 62.54 ± 1.56 years and a median follow up of 3.9 years were identified. Among patients with SIHD and moderate to severe ischemia by stress testing, PCI didn't show any benefit for the primary outcome of all-cause mortality compared to MT(RR = 0.85; 95% CI 0.646-1.12; p = 0.639). There was also no benefit in cardiovascular (CV) death (RR = 0.88 ; 95% CI 0.71-1.09; p = 0.18) or myocardial infarction (MI) (RR = 0.271; 95% CI 0.782-1.087; P = 0.327) in the PCI group as compared to MT. CONCLUSION Among patients with SIHD and evidence of moderate to severe ischemia by stress testing, PCI on top of MT appears to add no mortality benefit as compared to with MT alone.
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Osman M, Patel B, Munir MB, Kawsara A, Kheiri B, Balla S, Daggubati R, Michos ED, Alkhouli M. Sex-stratified analysis of the safety of percutaneous left atrial appendage occlusion. Catheter Cardiovasc Interv 2020; 97:885-892. [PMID: 33048417 DOI: 10.1002/ccd.29282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES AND BACKGROUND There is insufficient current evidence about whether sex impacts outcomes of percutaneous left atrial appendage occlusion (LAAO). The aim of this study was to investigate the association between sex and short-term outcomes of LAAO. METHODS Patients who were hospitalized and underwent LAAO from October 2015 to December 2017 in the National Readmission Database were queried. The primary endpoint of interest was major in-hospital adverse events. Secondary endpoints included, 30-day readmission rate, nonhome discharge, and cost of hospitalization. Propensity score matching (1:1) was performed to compare the outcomes among women and men. RESULTS A total of 9,281 patients were included in the current analysis [women = 3,659 (39%); men = 5,622 (61%)]. Comparing women to men, women had lower prevalence of diabetes mellitus (30.6% vs 35.7%, p < .01), heart failure (28.6% vs 30.8%, p = .03), vascular disease (55.5% vs 69.6%, p < .01) and renal failure (18.3% vs 21.2%, p < .01), and higher CHA2 DS2 VASc score (5 [IQR4-6] vs 4 [IQR3-6], p < .01). After propensity-score matching, women had higher rate of major in-hospital adverse events (2.8% vs 1.9%; p < .01), and nonhome discharges (11.4% vs 6.7%; p < .01). Additionally, 30-day readmission rate was higher among women (10% vs 8.6%, p = .03). CONCLUSION Among hospitalized patients undergoing LAAO, women carry higher risk for major in-hospital adverse events, nonhome discharge, and 30-day readmission rates.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Brijesh Patel
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Akram Kawsara
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ramesh Daggubati
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Osman M, Syed M, Patel B, Kheiri B, Kawsara A, Daggubati R. TCT CONNECT-175 Gender Based Outcomes of Impeller Pumps Percutaneous Ventricular Assist Devices. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Osman M, Patel B, Munir M, Kawsara A, Kheiri B, Daggubati R, Michos E, Alkhouli M. TCT CONNECT-445 Sex-Stratified Analysis of the Safety of Percutaneous Left Atrial Appendage Occlusion: An Insight From the National Readmission Database. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Radaideh Q, Osman M, Kheiri B, Al-Abdouh A, Barbarawi M, Jabri A, Adhaduk M, Bachuwa G, Tamis-Holland J, Shammas N. TCT CONNECT-318 Direct Oral Anticoagulants Versus Antiplatelet Therapy in Patients With Peripheral Arterial Disease: Meta-Analysis of Randomized Controlled Trials. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Harmon D, Regner S, Osman K, Shahan C, Kheiri B, Kadiyala M, Sokos G, Sengupta PP, Michos ED, Bianco C. Dramatic LDL-Cholesterol elevation with Ketogenic Diet: A Case Series. Am J Prev Cardiol 2020. [DOI: 10.1016/j.ajpc.2020.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Zayed Y, Barbarawi M, Kheiri B, Haykal T, Chahine A, Rashdan L, Dhillon H, Khaneki S, Bachuwa G, Seedahmed E. Initial Noninvasive Oxygenation Strategies in Subjects With De Novo Acute Hypoxemic Respiratory Failure. Respir Care 2020; 64:1433-1444. [PMID: 31653763 DOI: 10.4187/respcare.06981] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND De novo hypoxemic respiratory failure is defined as significant hypoxemia in the absence of chronic lung disease such as COPD, and excluding respiratory failure occurring in the immediate postoperative or postextubation period. We aimed to evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in patients with de novo hypoxemic respiratory failure. METHODS We performed electronic database searches of PubMed, Cochrane Library, and Embase from inception to December 2018 to include randomized controlled trials that compared various oxygenation strategies in cases of de novo hypoxemic respiratory failure occurring in adult subjects without a preexisting chronic lung disease and excluding respiratory failure in the immediate postoperative or postextubation periods. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrI). RESULTS 16 studies were included, involving 2,180 subjects with a mean age of 61 ± 17 y (66% were male; 46% of the included subjects were treated with conventional oxygen, 27.8% were treated with NIV, and 25.8% were treated with HFNC). Compared to conventional oxygen, NIV was associated with reduced intubation rates (OR 0.42, 95% CrI 0.26-0.62) but no significant reduction in short-term (OR 0.73, 95% CrI 0.47-1.02) or long-term mortality (OR 0.60, 95% CrI 0.29-1.06). There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes. In a sensitivity analysis, the results remained consistent after exclusion of studies that included subjects with respiratory failure secondary to cardiogenic pulmonary edema. CONCLUSION Among subjects with hypoxemic respiratory failure, NIV was associated with a significant reduction in intubation rates but not short- or long-term mortality when compared to conventional oxygen therapy. There was no significant difference between NIV and HFNC or between HFNC and conventional oxygen regarding all outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elfateh Seedahmed
- Department of Pulmonary and Critical Care, Hurley Medical Center/Michigan State University, Flint, Michigan
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Subahi A, Kheiri B, Yassin AS, Ali OE. Coronary Angiography in Patients Resuscitated From Cardiac Arrest Without ST-Segment Elevation: Does It Confer Survival Benefit? Cardiovascular Revascularization Medicine 2020; 21:989-991. [DOI: 10.1016/j.carrev.2019.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/31/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
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Zayed Y, Kheiri B, Barbarawi M, Rashdan L, Gakhal I, Ismail E, Kerbage J, Rizk F, Shafi S, Bala A, Sidahmed S, Bachuwa G, Seedahmed E. Effect of oxygenation modalities among patients with postoperative respiratory failure: a pairwise and network meta-analysis of randomized controlled trials. J Intensive Care 2020; 8:51. [PMID: 32690993 PMCID: PMC7366473 DOI: 10.1186/s40560-020-00468-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background Postoperative respiratory failure is associated with increased perioperative complications. Our aim is to compare outcomes between non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and standard oxygen in patients at high-risk for or with established postoperative respiratory failure. Methods Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to September 2019. We included only randomized controlled trials (RCTs) that compared NIV, HFNC, and standard oxygen in patients at high risk for or with established postoperative respiratory failure. We performed a Bayesian network meta-analysis to calculate the odds ratio (OR) and Bayesian 95% credible intervals (CrIs). Results Nine RCTs representing 1865 patients were included (the mean age was 61.6 ± 10.2 and 64.4% were males). In comparison with standard oxygen, NIV was associated with a significant reduction in intubation rate (OR 0.23; 95% Cr.I. 0.10–0.46), mortality (OR 0.45; 95% Cr.I. 0.27–0.71), and intensive care unit (ICU)-acquired infections (OR 0.43, 95% Cr.I. 0.25–0.70). Compared to standard oxygen, HFNC was associated with a significant reduction in intubation rate (OR 0.28, 95% Cr.I. 0.08–0.76) and ICU-acquired infections (OR 0.41; 95% Cr.I. 0.20–0.80), but not mortality (OR 0.58; 95% Cr.I. 0.26–1.22). There were no significant differences between HFNC and NIV regarding different outcomes. In a subgroup analysis, we observed a mortality benefit with NIV over standard oxygen in patients undergoing cardiothoracic surgeries but not in abdominal surgeries. Furthermore, in comparison with standard oxygen, NIV and HFNC were associated with lower intubation rates following cardiothoracic surgeries while only NIV reduced the intubation rates following abdominal surgeries. Conclusions Among patients with post-operative respiratory failure, HFNC and NIV were associated with significantly reduced rates of intubation and ICU-acquired infections compared with standard oxygen. Moreover, NIV was associated with reduced mortality in comparison with standard oxygen.
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Affiliation(s)
- Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon USA
| | - Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Laith Rashdan
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Inderdeep Gakhal
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Esra'a Ismail
- College of Human Medicine, Michigan State University, East Lansing, MI USA
| | - Josiane Kerbage
- Department of Anesthesia, Lebanese University, Beirut, Lebanon
| | - Fatima Rizk
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI USA
| | - Saadia Shafi
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Areeg Bala
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Shima Sidahmed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Suite 212, Flint, MI 48503 USA
| | - Elfateh Seedahmed
- Department of Pulmonary and Critical Care, Hurley Medical Center/Michigan State University, Flint, MI USA
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Barbarawi M, Kheiri B, Zayed Y, Barbarawi O, Dhillon H, Swaid B, Yelangi A, Sundus S, Bachuwa G, Alkotob ML, Manson JE. Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83 000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis. JAMA Cardiol 2020; 4:765-776. [PMID: 31215980 DOI: 10.1001/jamacardio.2019.1870] [Citation(s) in RCA: 214] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Observational studies have reported an association between low serum vitamin D levels and elevated risk of cardiovascular disease (CVD) events, but such studies cannot prove causation because of possible unmeasured confounding. Objective We conducted a meta-analysis of randomized clinical trials that tested the association of vitamin D supplementation with reduced CVD events and all-cause mortality. Data Sources Literature search through PubMed, the Cochrane Library, and Embase was completed by 2 reviewers from each database's inception to December 15, 2018. Study Selection Inclusion criteria were randomized clinical trials that reported the effect of long-term (≥1 year) vitamin D supplementation on CVD events and all-cause mortality. Studies that did not include cardiovascular outcomes were excluded. Data Extraction and Synthesis Data were abstracted independently by 2 authors. Random-effects models were used to report the risk ratios (RRs) and 95% CIs. Main Outcomes and Measures Major adverse cardiovascular events was the primary outcome, and rates of myocardial infarction, stroke or cerebrovascular accident, CVD mortality, and all-cause mortality were the secondary end points. Results Twenty-one randomized clinical trials were included (including 83 291 patients, of whom 41 669 received vitamin D and 41 622 received placebos). The mean (SD) age of trial participants was 65.8 (8.4) years; 61 943 (74.4%) were female. Only 4 trials had prespecified CVD as a primary end point. Vitamin D supplementation compared with placebo was not associated with reduced major adverse cardiovascular events (RR, 1.00 [95% CI, 0.95-1.06]; P = .85) nor the secondary end points of myocardial infarction (RR, 1.00 [95% CI, 0.93-1.08]; P = .92), stroke (RR, 1.06 [95% CI, 0.98-1.15]; P = .16), CVD mortality (RR, 0.98 [95% CI, 0.90-1.07]; P = .68), or all-cause mortality (RR, 0.97 [95% CI, 0.93-1.02]; P = .23). Results were generally consistent by sex, baseline 25-hydroxyvitamin D level, vitamin D dosage, formulation (daily vs bolus dosing), and presence or absence of concurrent calcium administration. Conclusions and Relevance In this updated meta-analysis, vitamin D supplementation was not associated with reduced major adverse cardiovascular events, individual CVD end points (myocardial infarction, stroke, CVD mortality), or all-cause mortality. The findings suggest that vitamin D supplementation does not confer cardiovascular protection and is not indicated for this purpose.
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Affiliation(s)
- Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Owais Barbarawi
- Department of Internal Medicine, Mutah University, Al-Karak, Jordan
| | - Harsukh Dhillon
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Bakr Swaid
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Anitha Yelangi
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Saira Sundus
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Osman M, Saleem M, Osman K, Kheiri B, Regner S, Radaideh Q, Moreland JA, Rao SV, Kapadia S. Radial versus femoral access for percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: Trial sequential analysis. Am Heart J 2020; 224:98-104. [PMID: 32361279 DOI: 10.1016/j.ahj.2020.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 03/14/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Randomized controlled trials (RCTs) have yielded conflicting results about the impact of transradial access (TRA) versus transfemoral access (TFA) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS We performed a trial sequential analysis (TSA) of RCTs comparing TRA and TFA in patients with STEMI. The outcomes of interest were 30-day mortality, major bleeding, major adverse cardiovascular events (MACE), myocardial infarction (MI), stroke, and access site complications. RESULTS A total of 17 studies with 11,992 patients were included in the current TSA. The TRA group had lower 30-day mortality (risk ratio [RR] 0.72, 95% CI 0.58-0.90, P = .003), major bleeding (RR 0.62, 95% CI 0.49-0.79, P = .0001), MACE (RR 0.74, 95% CI 0.58-0.93, P = .01), and access site complications (RR 0.37, 95% CI 0.28-0.48, P < .00001). There was no difference in MI and stroke between the 2groups. Applying TSA boundaries, the z-curve for 30-day mortality, major bleeding, MACE and access site complications crossed the conventional and the TSA boundaries, indicating firm evidence for better outcomes in the TRA group. For MI and stroke, the z-curve failed to cross the conventional and the TSA boundaries for both outcomes, indicating lack of signals of benefit or harm. CONCLUSIONS In the current TSA, the available data from RCTs support improved 30-day mortality, major bleeding, MACE and access site complication rates in STEMI patients treated by PCI through the radial access.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Maryam Saleem
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Khansa Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Sean Regner
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Qais Radaideh
- Division of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jason A Moreland
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sunil V Rao
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA
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Sidahmed S, Abdalla A, Kheiri B, Bala A, Salih M, Bachuwa G, Kafri Z, Kuderer NM, Lyman GH. Anticoagulants for the treatment of venous thromboembolism in patients with cancer: A comprehensive systematic review, pairwise and network meta-analysis. Crit Rev Oncol Hematol 2020; 152:103005. [PMID: 32540780 DOI: 10.1016/j.critrevonc.2020.103005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022] Open
Abstract
Cancer-associated venous thromboembolism (VTE) is associated with high VTE recurrence and bleeding. We included all randomized clinical trials that evaluated the efficacy and safety of various anticoagulants in cancer-associated VTE. Trial-level data were extracted from 13 trials. Aggregate odds ratios (ORs) were calculated using direct and network meta-analysis. The primary outcome was VTE (pulmonary embolism and/or deep vein thrombosis) recurrence. Secondary outcomes were major bleeding and all-cause mortality. We identified 13 trials with 4869 patient-years of follow-up (6595 total patients; mean age 62.4 ± 12.2; 50.4 % female; 17.7 % hematological malignancies). The most common cancer type was colorectal and 48 % had metastatic cancer at baseline. Compared to vitamin-K-antagonists (VKAs), non-vitamin-K-antagonist-oral-anticoagulants (NOACs) were associated with significantly reduced VTE recurrence (OR, 0.58; 95 % CI, 0.40-0.83) and reduced major bleeding risks (OR, 0.56; 95 % CI, 0.35-0.91). However, no differences were observed in the subgroup analysis of patients with active cancer. Although NOACs were associated with reduced VTE recurrence compared with low-molecular-weight-heparin (LMWHs) (OR, 0.46; 95 % CI, 0.25- 0.85), there was a significant increased major bleeding in high-quality trials. LMWHs were associated with significantly reduced VTE recurrence compared with VKAs (OR, 0.52; 95 % CI, 0.39-0.71) and similar bleeding risks. Conclusions: Among patients with cancer-associated VTE, NOACs were associated with significantly reduced VTE recurrence and bleeding compared with VKAs, however, with similar outcomes in the active cancer population. NOACs were associated with reduced VTE recurrence but higher bleeding risks compared with LMWHs. LMWHs were associated with significantly reduced VTE recurrence and similar bleeding compared with VKAs.
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Affiliation(s)
- Shima Sidahmed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI 48503, United States
| | - Ahmed Abdalla
- Division of Hematology & Oncology, Ascension St. John Hospital, Grosse Pointe Woods, MI 48236, United States.
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, United States
| | - Areeg Bala
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI 48503, United States
| | - Mohammed Salih
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI 48503, United States
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI 48503, United States
| | - Zyad Kafri
- Division of Hematology & Oncology, Ascension St. John Hospital, Grosse Pointe Woods, MI 48236, United States
| | - Nicole M Kuderer
- Advanced Cancer Research Group, and University of Washington, Seattle, WA 98109, United States
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Public Health Sciences and Clinical Research Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, United States
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Kheiri B, Simpson TF, Osman M, Kumar K, Radaideh Q, Rahmouni H, Golwala H, Divanji P, Cigarroa JE, Zahr F. Meta-analysis of Drug-Coated Balloons in the Treatment of De-Novo Coronary Artery Disease. Am J Cardiol 2020; 125:1451-1453. [PMID: 32241551 DOI: 10.1016/j.amjcard.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | - Timothy F Simpson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Kris Kumar
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Qais Radaideh
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | - Hind Rahmouni
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Punag Divanji
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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Kheiri B, Simpson TF, Osman M, Golwala H, Radaideh Q, Dalouk K, Stecker EC, Zahr F, Nazer B, Rahmouni H. Meta-Analysis of Secondary Prevention of Cryptogenic Stroke. Cardiovasc Revasc Med 2020; 21:1285-1290. [PMID: 32151594 DOI: 10.1016/j.carrev.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cryptogenic stroke and embolic stroke of undetermined source (ESUS) are a frequently encountered categories of ischemic stroke with an uncertain cause. METHODS We analyzed all randomized clinical trials (RCTs) that evaluated antithrombotic therapy and patent foramen ovale (PFO) closure in cryptogenic stroke and/or ESUS. We calculated aggregate hazard ratios (HRs) using direct and network meta-analysis. The primary outcome was recurrent ischemic stroke. RESULTS Ten RCTs with a total of 16,876 patients, randomizing 32,143 patient-years of follow-up (mean age 61.2 ± 13.5 with 39.2% female) were identified. Anticoagulation therapy was associated with significantly reduced recurrent ischemic stroke compared with antiplatelet therapy (HR = 0.66; [95% confidence interval (CI) = 0.47-0.94]). Meta-regression analysis showed significantly reduced recurrent stroke with longer duration of therapy, and significantly increased events with advanced age. Significant interactions were observed based on the presence of PFO, stroke type, and anticoagulant used. There were no significant differences with regard to the composite ischemic outcome, transient ischemic attack, any death, major bleeding, or intracranial bleeding. In the network meta-analysis, compared to antiplatelet therapy, warfarin (HR = 0.31; [95% credible interval (CrI) = 0.12-0.68]) and PFO closure (HR = 0.14; 95% CrI = 0.05-0.31]) were associated with significantly reduced recurrent ischemic stroke. In rank order, PFO closure was associated with the best outcome, followed by warfarin. CONCLUSIONS Among patients with cryptogenic stroke, anticoagulation therapy, as compared with antiplatelet therapy is associated with lower rate of recurrent stroke. The small sample size and high heterogeneity with regards to bleeding outcomes require further large trials. In patients with PFO, closure and warfarin are associated with the lowest rates of recurrent stroke.
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Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Timothy F Simpson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Qais Radaideh
- Midwest Cardiovascular Research Foundation, Davenport, Iowa, IA, USA
| | - Khidir Dalouk
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Hind Rahmouni
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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Osman M, Regner SR, Munir MB, Osman K, Benjamin M, Kheiri B, McCarthy P, Balla S, Bianco C. TARGETED TEMPERATURE MANAGEMENT IN SURVIVALS OF CARDIAC ARREST WITH NON-SHOCKABLE RHYTHMS: A META-ANALYSIS AND TRIAL SEQUENTIAL ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Osman M, Balla S, Kheiri B, Farjo P, Ghaffar YA, Shigle AJ, Patel K, Zahr F, Alkhouli M. TICAGRELOR VERSUS PRASUGREL IN PATIENTS WITH ACUTE CORONARY SYNDROME: AN INSIGHT FROM A NETWORK META-ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kheiri B, Rao SV, Osman M, Simpson TF, Barbarawi M, Zayed Y, Dhillon HN, Alkhouli M, Golwala H, Zahr F, Bhatt DL, Stone GW, Cigarroa JE. Meta-analysis of bivalirudin versus heparin in transradial coronary interventions. Catheter Cardiovasc Interv 2020; 96:1240-1248. [PMID: 32091668 DOI: 10.1002/ccd.28800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/08/2020] [Accepted: 02/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We sought to evaluate the efficacy and safety of bivalirudin versus heparin in patients with coronary artery disease undergoing transradial artery coronary intervention (TRI). BACKGROUND Bivalirudin and radial artery access are independently associated with improved cardiovascular outcomes. However, data supporting a strategy of combining both to achieve additive improvements in cardiovascular outcomes provide conflicting results. METHODS A systematic search was performed to identify randomized controlled trials (RCTs) of bivalirudin, in which vascular access sites were reported. The primary outcome was net adverse clinical events (NACE) at 30 days. Secondary outcomes were long-term NACE, short-, and long-term major adverse cardiovascular events, all-cause mortality, myocardial infarction, unplanned revascularization, stent thrombosis, and major bleeding. RESULTS We identified 10 RCTs, including 16,328 patients who underwent TRI (mean age 64.6 ± 15.7 years, 72.5% male). Bivalirudin use was associated with decreased 30-day NACE compared with heparin (6.3 vs. 7.4%; risk ratio [RR] = 0.87; 95% confidence interval [CI] = 0.76-0.99; p = .04; number needed to treat = 91). No significant interactions were observed based on clinical presentation, administration of P2Y12 inhibitors, or glycoprotein IIb/IIIa-receptor inhibitors (GPI) use. There were no significant differences between groups in any prespecified secondary outcomes. There was, however, a significant reduction of major bleeding in the bivalirudin group compared with heparin when used in combination with routine GPI (RR = 0.41; 95% CI = 0.19-0.90; p = .03). CONCLUSIONS Among patients undergoing TRI, use of bivalirudin was associated with significantly reduced 30-day NACE compared with heparin. There was no significant difference in long term NACE, ischemic, or bleeding events compared with heparin.
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Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Timothy F Simpson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Mahmoud Barbarawi
- Division of Cardiology, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Yazan Zayed
- Division of Cardiology, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Harsukh N Dhillon
- Division of Cardiology, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gregg W Stone
- Columbia University Medical Center, New York-Presbyterian Hospital, New York, New York.,Cardiovascular Research Foundation, New York, New York
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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Sidahmed S, Abdalla A, Kheiri B, Bachuwa G. Abstract P5-12-10: Tamoxifen versus anastrozole as adjuvant therapy in early stage breast cancer in premenopausal women on ovarian function suppression: A meta-analysis of randomized clinical trials. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-12-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Different strategies have been studied in adjuvant treatment for hormone positive early stage breast cancer. The addition of ovarian function suppression (OFS) therapy to Tamoxifen in premenopausal women was proven to prolong disease-free survival and overall survival compared with Tamoxifen alone. However, trials that examined the use of anastrozole inhibitor (AI) in the presence of OFS in comparison to Tamoxifen with OFS showed contradicting results. Therefore, we conducted this meta-analysis of randomized clinical trials (RCTs) comparing these two approaches. Methods: A comprehensive search of the electronic database (PubMed) from inception to July 2019 was conducted to identify all RCTs that compared OFS with Tamoxifen versus OFS with AI in premenopausal females with breast cancer. The primary endpoint was event-free survival, defined as females without events (local or distant recurrence, cancer in the contralateral breast, secondary non-breast malignancy, or death) at the longest follow-up duration. The secondary endpoints were death, the incidence of distant metastasis, and the incidence of contralateral breast cancer. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for all dichotomous data. Heterogeneity was explored by the Cochran Q statistic and I-squared (I2) statistic. P-values <0.05 were considered statistically significant. Results: We included 4 RCTs with 7,202 total patients (mean age 43.8). At baseline, T1 disease represented 53.5% and nodal positive disease was 44.5%. After a median follow-up period of 78 months, there was a non-significant reduction of event-free survival with the AI group compared with the Tamoxifen group (OR=1.13; 95% CI=0.87-1.47; P=0.37). In addition, there were no significant differences between both groups with regard to deaths (OR=1.11; 95% CI=0.50-2.47; P=0.8). The incidence of distant metastasis did not differ between both groups (OR=1.02; 95% CI=0.82-1.26; P=0.86). Similarly, there were no differences in the incidence of contralateral breast cancer between both groups (OR=1.30; 95% CI=0.86-1.96; P=0.21). Conclusions: Among premenopausal women with early breast cancer, the use of AI plus OFS versus Tamoxifen plus OFS was not associated with significantly reduced event-free survival. Given the limited number of RCTs and low events, further, adequately powered trials are needed to validate this finding.
Citation Format: Shima Sidahmed, Ahmed Abdalla, Babikir Kheiri, Ghassan Bachuwa. Tamoxifen versus anastrozole as adjuvant therapy in early stage breast cancer in premenopausal women on ovarian function suppression: A meta-analysis of randomized clinical trials [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-10.
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Osman M, Khan SU, Farjo PD, Chima N, Kheiri B, Zahr F, Alkhouli M. Meta-Analysis Comparing Complete Versus Infarct-Related Artery Revascularization in Patients With ST-Elevation Myocardial Infarction and Multivessel Coronary Disease. Am J Cardiol 2020; 125:513-520. [PMID: 31812228 DOI: 10.1016/j.amjcard.2019.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/09/2019] [Accepted: 11/13/2019] [Indexed: 01/09/2023]
Abstract
A strategy of complete revascularization (CR) versus infarct-related artery revascularization (IRA) in patients with ST-elevation myocardial infarction (STEMI) continues to be a subject of debate. We performed an updated meta-analysis to compare the 2 strategies. Outcomes of interest included major adverse cardiovascular events (MACE), cardiovascular mortality, all-cause mortality, stroke, repeat revascularization, myocardial infarction, and contrast-induced nephropathy. Ten randomized trials including 7,423 patients (CR = 3,574 and IRA = 3,849), with a follow-up of 2.0 ± 0.8 years were included. There was a significant reduction in MACE with CR versus IRA (10.7% vs 18.6%, relative risk [RR] 0.64, 95% confidence interval [CI] 0.51 to 0.81, p = 0.002, I2 = 66%), with higher risk reduction with immediate versus stages revascularization (RR 0.40, 95% CI 0.32 to 0.5 vs RR 0.69, 95% CI 0.54 to 0.89, P-interaction = 0.002). Complete revascularization was associated with lower rates of repeat revascularization (4.0% vs 11.7%, RR 0.44, 95% CI 0.28 to 0.70, p <0.0001, I2 = 81%), and a nonsignificant trend toward lower cardiovascular mortality (2.8% vs 3.7%, RR 0.78, 95% CI 0.60 to 1.03, p = 0.08, I2 = 0%). However, there was no difference between the 2 strategies in all-cause mortality (4.6% vs 4.8%, RR 0.90, 95% CI 0.73 to 1.12, p = 0.36, I2 = 0%), myocardial infarction (5.2% vs 6.5%, RR 0.73, 95% CI, 0.58 to 1.08, p = 0.08, I2 = 30%), stroke (1.5% vs 1.2%, RR 1.14, 95% CI 0.56 to 2.29, p = 0.33, I2 = 14%), or contrast-induced nephropathy (1.6% vs 1.2%, RR 1.35, 95% CI 0.85 to 2.15, p = 0.78, I2 = 0%). In conclusion, CR in patients with STEMI is associated with significant reduction in MACE compared with IRA. This reduction is derived mainly by the low rates of repeat revascularization in the CR group.
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Kheiri B, Zayed Y, Barbarawi M, Osman M, Chahine A, Ahmed S, Bachuwa G, Hassan M, Alkhouli M, Feldman T, Bhatt DL. Interventions for Secondary Mitral Regurgitation in Patients With Heart Failure: A Network Meta-Analysis of Randomized Controlled Comparisons of Surgery, Medical Therapy and Transcatheter Intervention. Cardiovascular Revascularization Medicine 2020; 21:155-163. [DOI: 10.1016/j.carrev.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 01/17/2023]
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Kheiri B, Osman M, Bakhit A, Radaideh Q, Barbarawi M, Zayed Y, Golwala H, Zahr F, Stone GW, Bhatt DL. Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk Patients. Am J Med 2020; 133:e38-e41. [PMID: 31295442 DOI: 10.1016/j.amjmed.2019.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE This study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients. METHODS An electronic database search was conducted for randomized controlled trials (RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. RESULTS Five RCTs were identified with a total of 3,072 patients (mean age 74.5 ± 6.1 and 64.8% male). Compared with SAVR, TAVR was associated with a significantly reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99; P = .049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P < .01), and post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P < .01), along with a significantly improved quality-of-life at 1-year. However, TAVR was associated with significantly increased rates of paravalvular leak (HR = 4.09; 95% CI = 1.92-8.69; P < .01) and pacemaker insertion (HR = 2.81; 95% CI = 1.85-4.28; P < .01) compared with SAVR. CONCLUSION Among older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.
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Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown
| | - Ahmed Bakhit
- Division of Cardiology, Saint Vincent Hospital, Worcester, Mass
| | - Qais Radaideh
- Midwest Cardiovascular Research Foundation, Davenport, Iowa
| | - Mahmoud Barbarawi
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland
| | - Yazan Zayed
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland
| | - Harsh Golwala
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland
| | - Gregg W Stone
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Cardiovascular Research Foundation, New York, NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Mass.
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Haykal T, Samji V, Zayed Y, Gakhal I, Dhillon H, Kheiri B, Kerbage J, Veerapaneni V, Obeid M, Danish R, Bachuwa G. The role of vitamin D supplementation for primary prevention of cancer: meta-analysis of randomized controlled trials. J Community Hosp Intern Med Perspect 2019; 9:480-488. [PMID: 32002154 PMCID: PMC6968692 DOI: 10.1080/20009666.2019.1701839] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/26/2019] [Indexed: 12/31/2022] Open
Abstract
Background: In the USA cancer is the second leading cause of mortality, as such, primary prevention of cancer is a major public health concern. Vitamin D supplementation has been studied as a primary prevention method for multiple diseases including cardiovascular disease, osteoporosis, diabetes mellitus and cancer. The role of Vitamin D as primary prevention of cancer is still controversial. With fast emergence of large randomized controlled trials (RCTs) in that regards, we aimed to evaluate the efficacy of Vitamin D supplementation as primary prophylaxis for cancer. Methods: A comprehensive electronic database search was conducted for all RCTs where comparison of Vitamin D supplementation versus placebo for the prevention of any type of disease with at least 3 years of Vitamin D supplementation was used and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality and cancer incidence. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up. Results: We included 10 RCTs with 79,055 total patients, mean age of 68.07 years, a female percentage of 78.02% and a minimum follow-up of 4 years and more. Vitamin D was associated with significant reduction of cancer-related mortality compared with placebo (RR 0.87; 95% CI: 0.79–0.96; P = 0.05: I2 = 0%). Compared with placebo, Vitamin D was not associated with significant reduction of cancer incidence (RR: 0.96; 95% CI: 0.86–1.07; P = 0.46; I2 = 31%). Conclusion: With inclusion of studies, which did not primarily examine vitamin D for the purpose of preventing cancer or reducing cancer mortality our meta-analysis highlights that the use of vitamin D supplementation for primary prevention of cancer is encouraged as it does possibly decrease cancer-related mortality once cancer is diagnosed; however, it has no role or effect on cancer incidence.
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Affiliation(s)
- Tarek Haykal
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Varun Samji
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Inderdeep Gakhal
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Harsukh Dhillon
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Josiane Kerbage
- Department of Anesthesiology, Lebanese University, Beirut, Lebanon
| | - Vijaysai Veerapaneni
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Michele Obeid
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Rizwan Danish
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.,College of Human Medicine, Michigan State University, East Lansing, MI, USA
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Barbarawi M, Zayed Y, Hamid K, Kheiri B, Barbarawi O, Sundus S, Rashdan L, Alabdouh A, Chahine A, Bachuwa G, Alkotob ML. Comparison of Coronary Artery Bypass Grafting and Drug-Eluting Stents in Patients with Left Main Coronary Artery Disease and Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Cardiovascular Revascularization Medicine 2019; 20:1184-1189. [DOI: 10.1016/j.carrev.2019.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
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Kheiri B, Barbarawi M, Zayed Y, Hicks M, Osman M, Rashdan L, Kyi HH, Bachuwa G, Hassan M, Stecker EC, Nazer B, Bhatt DL. Antiarrhythmic Drugs or Catheter Ablation in the Management of Ventricular Tachyarrhythmias in Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Circ Arrhythm Electrophysiol 2019; 12:e007600. [PMID: 31698933 DOI: 10.1161/circep.119.007600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with an implantable cardioverter-defibrillator (ICD), shocks are associated with increased morbidity and mortality. Therefore, we conducted this study to evaluate the efficacy and safety of antiarrhythmic drugs and catheter ablation (CA) in the treatment of ventricular tachyarrhythmias (VT) in patients with an ICD. METHODS An electronic database search for randomized controlled trials that evaluated antiarrhythmic drugs and CA in patients with ICD was conducted. The primary outcome was recurrent VT. Secondary outcomes were ICD shocks and any deaths. Bayesian and frequentist network meta-analyses were performed to calculate hazard ratios (HRs) and 95% credible intervals (CrIs)/CIs. RESULTS Twenty-two randomized controlled trials were identified (3828 total patients; age 64.3±11.4; 79% males). The use of amiodarone was associated with a significantly reduced rate of VT recurrence compared with control (HR=0.34 [95% CrI=0.15-0.74]; absolute risk difference=-0.23 [95% CrI=-0.23 to -0.09]; number needed to treat=4). Sotalol was associated with increased risk of VT recurrence compared with amiodarone (HR=2.88 [95% CrI=1.35-6.46]). Compared with control, amiodarone (HR=0.33 [95% CrI=0.15-0.76]; absolute risk difference=-0.17 [95% CrI=-0.32 to -0.06]; number needed to treat=6) and CA (HR=0.52 [95% CrI=0.30-0.89; absolute risk difference=-0.12 [95% CrI=-0.24 to -0.03]; number needed to treat=8) were associated with significantly reduced ICD shocks. Compared with amiodarone, sotalol was associated with significantly increased ICD shocks (HR=2.70 [95% CrI=1.17-6.71]). The rate of death was not significantly different between the competing strategies. The node-splitting method showed no inconsistency. CONCLUSIONS Among patients with an ICD, amiodarone significantly reduced VT recurrence and ICD shocks, while CA reduced ICD shocks. Sotalol significantly increased VT recurrence and ICD shocks compared with amiodarone. The long-term side effects of amiodarone and early complications of CA should be weighed carefully according to specific patient characteristics.
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Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (B.K., E.C.S., B.N.)
| | - Mahmoud Barbarawi
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Yazan Zayed
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Michael Hicks
- Michigan Medicine, University of Michigan, Ann Arbor (M. Hicks)
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown (M.O.)
| | - Laith Rashdan
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Htay Htay Kyi
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Ghassan Bachuwa
- Department of Internal Medicine (M.B., Y.Z., L.R., H.H.K., G.B.), Hurley Medical Center/Michigan State University, Flint
| | - Mustafa Hassan
- Division of Cardiology (M. Hassan), Hurley Medical Center/Michigan State University, Flint
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (B.K., E.C.S., B.N.)
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (B.K., E.C.S., B.N.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
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Barbarawi M, Zayed Y, Kheiri B, Barbarawi O, Al-Abdouh A, Dhillon H, Rizk F, Bachuwa G, Alkotob ML. Optimal timing of coronary intervention in patients resuscitated from cardiac arrest without ST-segment elevation myocardial infarction (NSTEMI): A systematic review and meta-analysis. Resuscitation 2019; 144:137-144. [DOI: 10.1016/j.resuscitation.2019.06.279] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/11/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023]
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Osman M, Kheiri B, Shigle AJ, Saleem M, Osman K, Sengupta PP, Moreland JA. Ticagrelor after pharmacological thrombolysis in patients with ST-segment elevation myocardial infarctions: insight from a trial sequential analysis. J Thromb Thrombolysis 2019; 48:661-667. [PMID: 31506887 DOI: 10.1007/s11239-019-01953-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Few randomized controlled trials (RCTs) have compared ticagrelor to clopidogrel after thrombolytic therapy in patients with ST-segment elevation myocardial infarction (STEMI). To assess the quality of the current evidence, a trial sequential analysis (TSA) of all the available RCTs was performed. A literature search through electronic databases for relevant RCTs was completed. Trial sequential boundaries were applied to the meta-analysis to guard against statistical error, calculate the information size (IS), and assess the quality of the currently available evidence. The safety outcome was bleeding at 30-days and the efficacy outcome was major adverse cardiovascular events at 30-days. There were 3 RCTs with a total of 3999 patients were included. For the safety and efficacy outcomes, there was no difference between the ticagrelor and clopidogrel groups (RR 0.94; 95% CI 0.56-1.60, p = 0.83) and (RR 0.87; 95% CI 0.49-1.52, p = 0.62), respectively. The corresponding TSA revealed an IS of 20,928 and 37,266 for safety and efficacy outcomes, respectively. The Z-curves for both outcomes failed to cross the conventional boundary of significance and TSA boundary, indicating no statistical difference between the ticagrelor and clopidogrel group and lack of firm evidence from the currently available RCTs to draw conclusion. Based on the current available RCTs, there is not enough evidence to support or refute better outcomes with ticagrelor in patients with STEMI treated with thrombolytics. Larger RCTs with enough power are needed before firm recommendations can be applied.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Amanda Jo Shigle
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Maryam Saleem
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | | | - Partho P Sengupta
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Jason A Moreland
- Division of Cardiology, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506, USA
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Kheiri B, Osman M, Bachuwa G, Cigarroa JE. Trial Sequential Analysis of Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Intervention. Am J Cardiol 2019; 124:823-824. [PMID: 31272706 DOI: 10.1016/j.amjcard.2019.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Babikir Kheiri
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Joaquin E Cigarroa
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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81
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Subahi A, Osman M, Adegbala O, Abubakar H, Kheiri B, Yassin AS, Khalid M, Akintoye E, Eljack A, Osman K, Alkhouli M. Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions. Vascular 2019; 28:81-86. [PMID: 31382836 DOI: 10.1177/1708538119868615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Percutaneous peripheral arterial intervention (PPAI) patients are at a high risk of developing heparin-induced thrombocytopenia due to the need for repeated and prolonged heparin exposure. We sought to investigate the incidence, outcomes, and economic impact of heparin-induced thrombocytopenia post-PPAI utilizing the National Inpatient Sample. Methods All patients who underwent PPAI (age ≥18 years) from 2007 to 2014 were identified by using ICD-9-CM codes. Patients were then classified into two groups based on the presence or absence of heparin-induced thrombocytopenia during hospitalization. In-hospital outcomes were compared between the two groups after propensity-score matching to account for differences in baseline characteristics. Results Heparin-induced thrombocytopenia was reported in 527 patients (0.23%). After adjusting for patient-level and hospital-level characteristics, in-hospital mortality differences were not significantly different between patients with heparin-induced thrombocytopenia vs. those without heparin-induced thrombocytopenia (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.67 to 1.57, p = 0.951). However, PPAI patients with heparin-induced thrombocytopenia were more likely to develop ischemic stroke (OR 3.84, 95%CI 1.26 to 11.75, p = 0.018), deep venous thrombosis/pulmonary embolism (OR 1.32, 95%CI 0.79 to 1.79, p = 0.078), and acute kidney injury requiring dialysis (OR 4.04, 95%CI 1.72 to 9.50, p = 0.001). Furthermore, post-PPAI patients who developed heparin-induced thrombocytopenia had longer hospitalizations (13.8 vs. 9.8 days, p < 0.0001), higher cost of stay ($62,022 vs. $44,904, p < 0.0001), and higher rates of non-routine home discharges (50.15% vs. 42.19%, p = 0.013). Conclusion Among patients who underwent PPAI, heparin-induced thrombocytopenia was associated with a higher risk of venous thrombosis/pulmonary embolism, ischemic stroke, acute kidney injury requiring dialysis, prolonged hospital stay, and increased cost.
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Affiliation(s)
- Ahmed Subahi
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Mohammed Osman
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Oluwole Adegbala
- Department of Internal Medicine, Englewood Hospital and Medical Center, University-Hackensack Meridian School of Medicine, Englewood, NJ, USA
| | - Hossam Abubakar
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ahmed S Yassin
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Mowyad Khalid
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Emmanuel Akintoye
- Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Ammar Eljack
- Department of Internal Medicine, Beaumont Hospital, Dearborn, MI, USA
| | - Khansa Osman
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Mohamad Alkhouli
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA
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Osman M, Ghaffar YA, Foster T, Osman K, Alqahtani F, Shah K, Kheiri B, Alkhouli M. Meta-Analysis of Outcomes of Transcatheter Aortic Valve Implantation Among Patients With Low Gradient Severe Aortic Stenosis. Am J Cardiol 2019; 124:423-429. [PMID: 31138402 DOI: 10.1016/j.amjcard.2019.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an effective therapy for patients with severe aortic stenosis (AS). However, data on TAVI outcomes in patients with low gradient (LG) AS are limited. We performed a meta-analysis of studies comparing TAVI outcomes between patients with classic high gradient (HG) and LG AS through November 2018. The 30-day mortality, mid-term all-cause, and cardiovascular mortality at maximum follow-up were compared between patients with HG and LG AS (Pairwise meta-analysis), and between the three distinct groups of AS including HG, paradoxical low-flow low-gradient and low gradient with reduced ejection fraction (rEF-LG) (Network meta-analysis). Nineteen studies (n = 27,204 patients) met the inclusion criteria. The HG group had less 30-day, mid-term all-cause and cardiovascular mortality compared with the low-gradient AS group overall, (6% vs 7.5%, OR 0.76, 95% CI 0.66 to 0.87, I2 = 18%), (21% vs 29%, OR 0.59, 95% CI 0.52 to 0.67, I2 = 62%), and (12.6% vs 18.7%, OR 0.61, 95% CI 0.49 to 0.76, I2 = 62%), respectively, p <0.0001. These outcomes were confirmed in a trial sequential analysis in which the cumulative Z-curve crossed the conventional test boundary as well as the trial sequential monitoring boundary for all outcomes. The network meta-analysis revealed that patients with rEF-LG had similar outcomes to those with pLFLG, and both had worse outcomes than patients with classic HG AS. In conclusion patients with classic HG have better 30-day mortality, mid-term all-cause and cardiovascular mortality compared with LG patients following TAVI. Among patients with LG severe AS, TAVI outcomes were similar in patients with rEF-LG and pLFLG.
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83
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Kheiri B, Abdalla A, Osman M, Barbarawi M, Zayed Y, Haykal T, Chahine A, Bachuwa G, Hassan M, Bhatt DL. Personalized antiplatelet therapy in patients with coronary artery disease undergoing percutaneous coronary intervention: A network meta-analysis of randomized clinical trials. Catheter Cardiovasc Interv 2019; 94:181-186. [PMID: 30628754 DOI: 10.1002/ccd.28075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/09/2018] [Accepted: 12/26/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to evaluate the efficacy and safety of genotype- and phenotype-guided intensified antiplatelet therapy compared with conventional therapy in patients undergoing stent implantation. BACKGROUND Although potent P2Y12 receptor inhibitors are recommended for percutaneous coronary intervention (PCI)-treated acute coronary syndrome, their usage is limited by a high bleeding risk. Therefore, personalized antiplatelet therapy could provide a valuable foundation for selection of antiplatelet therapy in this population. METHODS We conducted a Bayesian network meta-analysis for all randomized clinical trials (RCTs) that evaluated genotype- and/or phenotype-guided therapy in PCI-treated coronary artery disease. RESULTS Thirteen RCTs were included with a total of 6,845 patients. The results showed no significant differences in major adverse cardiovascular events (MACE) between the treatment options ((genotype guided vs. standard of care; OR 0.64; 95% CI: 0.38-1.05) and (phenotype vs. standard of care; OR 0.93; 95% CI: 0.54-1.37)). In addition, no significant differences were demonstrated in bleeding events ((genotype guided vs. standard of care; OR 0.73; 95% CI: 0.45-1.25) and (phenotype vs. standard of care; OR 0.90; 95% CI: 0.62-1.39)). CONCLUSIONS In this mixed treatment meta-analysis of RCTs, neither genotype- nor phenotype-guided antiplatelet therapy in patients with PCI-treated coronary artery disease was superior to conventional therapy.
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Affiliation(s)
- Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Ahmed Abdalla
- Division of Hematology & Oncology, St. John Hospital, Grosse Pointe Woods, Michigan
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Tarek Haykal
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Adam Chahine
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Mustafa Hassan
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
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Barbarawi M, Zayed Y, Kheiri B, Gakhal I, Barbarawi O, Bala A, Alabdouh A, Abdalla A, Rizk F, Bachuwa G, Katato K. The role of anticoagulation in venous thromboembolism primary prophylaxis in patients with malignancy: A systematic review and meta-analysis of randomized controlled trials. Thromb Res 2019; 181:36-45. [PMID: 31349093 DOI: 10.1016/j.thromres.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common cause of morbidity and mortality among patients with cancer. As such, we conducted a meta-analysis of randomized controlled trials (RCTs) that evaluated anticoagulants as primary prophylaxis against VTE in cancer patients. METHODS Pubmed/MEDLINE, Embase, and the Cochrane Library were screened for all RCTs that used anticoagulation therapy in cancer patients for primary prevention of VTE. The primary outcomes were VTE events. Secondary outcomes included all-cause mortality, VTE-related mortality and major bleeding. A random effects model was used to report the risk ratios (RR) with 95% confidence intervals (CIs), and odds ratios (ORs) with Bayesian 95% credible intervals for both direct and network meta-analyses, respectively. RESULTS Twenty-four RCTs were included totaling 13,338 patients (7197 received anticoagulation and 6141 received placebo). The mean age ranged between 54.6 and 68.1 years, with 50.5% male. Compared with placebo, low-molecular-weight heparin (LMWH) or direct Xa inhibitors were associated with lower VTE events (RR 0.58; 95%CI 0.48-0.69, P < 0.001) and (RR 0.39; 95%CI 0.24-0.63, p < 0.001), respectively. LMWH was associated with decreased VTE and all-cause mortality when compared with placebo (P < 0.05). Regarding safety outcomes, LMWH and direct Xa inhibitors were not associated with increased risks of major bleeding (P > 0.05) when compared with placebo. Results regarding VTE events and major bleeding were consistent in both lung and pancreatic cancers. CONCLUSIONS Both LMWH and direct Xa inhibitors were associated with a lower VTE events compared with placebo. However, this potentially protective effect must be balanced against the possible increased risk of bleeding for some patients.
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Affiliation(s)
- Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA.
| | - Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Inderdeep Gakhal
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Owais Barbarawi
- Department of Internal medicine, Mutah University, Al-Karak, Jordan
| | - Areeg Bala
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Ahmad Alabdouh
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA
| | - Ahmed Abdalla
- Division of Hematology and Oncology, St. John Hospital, Grosse Pointe Woods, MI, USA
| | - Fatima Rizk
- Michigan State University, College of Osteopathic Medicine, East Lansing, MI, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI, USA
| | - Khalil Katato
- Division of Hematology and Oncology, Hurley Medical Center, Michigan State University, Flint, MI, USA
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Osman M, Kheiri B, Munir MB, Moreland JA, Balla S, Kapadia S. The fading role of triple therapy in patients with atrial fibrillation and acute coronary syndrome: a Bayesian network meta-analysis. J Thromb Thrombolysis 2019; 48:516-518. [DOI: 10.1007/s11239-019-01896-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kheiri B, Barbarawi M, Bachuwa G, Shapiro MD. Aspirin for Primary Prevention of Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2019; 12:e005846. [DOI: 10.1161/circoutcomes.119.005846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI (B.K., M.B., G.B.)
| | - Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI (B.K., M.B., G.B.)
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI (B.K., M.B., G.B.)
| | - Michael D. Shapiro
- Center for Preventive Cardiology, Knight Cardiovascular Institute at Oregon Health and Science University, Portland, OR (M.D.S.)
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Barbarawi M, Kheiri B, Zayed Y, Barbarawi O, Chahine A, Haykal T, Kanugula AK, Bachuwa G, Alkotob ML, Bhatt DL. Meta‐analysis of optimal timing of coronary intervention in non‐ST‐elevation acute coronary syndrome. Catheter Cardiovasc Interv 2019; 95:185-193. [DOI: 10.1002/ccd.28280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/29/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Mahmoud Barbarawi
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Babikir Kheiri
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Yazan Zayed
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Owais Barbarawi
- Department of Internal MedicineMutah University Al‐Karak Jordan
| | - Adam Chahine
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Tarek Haykal
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Ashok K. Kanugula
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Ghassan Bachuwa
- Department of Internal MedicineHurley Medical Center/Michigan State University Flint Michigan
| | - Mohammad L. Alkotob
- Division of CardiologyHurley Medical Center/Michigan State University Flint Michigan
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School Boston Massachusetts
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88
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Haykal T, Barbarawi M, Zayed Y, Kheiri B, Yelangi A, Dhillon H, Goranta S, Chahine A, Samji V, Bachuwa G, Katato K. Safety and efficacy of aspirin for primary prevention of cancer: A meta-analysis of randomized controlled trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1533 Background: In the United States, cancer is the second leading cause of mortality, and millions more battle cancer worldwide. As such, primary prevention of cancer is a major interest globally. Aspirin has been studied as a primary prevention method for multiple diseases, mainly cardiovascular disease and various forms of cancer. The role of aspirin as a primary prevention of cancer is still controversial and may be more beneficial in certain cancers over others. With rapidly surfacing large randomized controlled trials (RCTs) studying this subject, we aimed to evaluate the efficacy and safety of aspirin as a primary prophylaxis for cancer. Methods: A comprehensive electronic database search was conducted for all RCTs that compared aspirin versus placebo for the prevention of any type of disease, and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality. Secondary outcomes were cancer incidence, all-cause mortality, major bleeding, any bleeding and gastrointestinal (GI) bleeding. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up period. Results: We included 16 RCTs with 104,018total patients, mean age of 60.51 years, mean follow-up of 5.48 years, and a male percentage of 38.72%. We found that aspirin was not associated with a significant reduction of cancer-related mortality compared with placebo (RR 0.99; 95% CI: 0.87-1.12; P = 0.85: I2= 41%). Compared with placebo, aspirin was not associated with significant reduction of all-cause mortality (RR 0.97; 95% CI: 0.92-1.02; P = 0.19; I2= 13%) or cancer incidence (RR: 0.98; 95% CI: 0.92-1.04; P = 0.43; I2= 16%). However, aspirin treatment was associated with significantly increased risks of any bleeding (RR 1.63; 95% CI: 1.31-2.03; P < 0.01), major bleeding (RR 1.41; 95% CI: 1.26-1.57; P < 0.01), and GI bleeding (RR 1.85; 95% CI: 1.38-2.48; P < 0.01) compared with placebo. Conclusions: Our study did not find any significant reductions in cancer-related mortality or cancer incidence when compared with placebo. Our study also highlights the dangers of aspirin for primary prevention of cancer as aspirin was found to cause higher rates of bleeding (any bleeding, major bleeding, and GI bleeding) compared to placebo at the longest follow-up period with no significant benefit in cancer primary prevention.
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Affiliation(s)
- Tarek Haykal
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | - Yazan Zayed
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Babikir Kheiri
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Anitha Yelangi
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | - Sowmya Goranta
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Adam Chahine
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Varun Samji
- Hurley Medical Center/Michigan State University, Flint, MI
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89
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Samji V, Haykal T, Zayed Y, Gakhal I, Veerapaneni V, Obeid M, Kheiri B, Badami S, Bachuwa G, Danish R. Role of vitamin D supplementation for primary prevention of cancer: Meta-analysis of randomized controlled trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1534 Background: In the United States cancer is the second leading cause of mortality, as such, primary prevention of cancer is a major public health concern. Vitamin D supplementation has been studied as a primary prevention method for multiple diseases including cardiovascular disease, osteoporosis, diabetes mellitus and cancer. The role of aspirin as primary prevention of cancer is still controversial. With fast emergence of large randomized controlled trials (RCTs) in that regards, we aimed to evaluate the efficacy of Vitamin D supplementation as primary prophylaxis for cancer. Methods: A comprehensive electronic database search was conducted for all RCTs where comparison of Vitamin D supplementation versus placebo for the prevention of any type of disease with at least 3 years of Vitamin D supplementation was used and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality and cancer incidence. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up. Results: We included 10 RCTs with 79,055 total patients, mean age of 68.07 years, a female percentage of 78.02% and a minimum follow-up of 4 years and more. Vitamin D was associated with significant reduction of cancer-related mortality compared with placebo (RR 0.87; 95% CI: 0.79-0.96; P = 0.05: I2= 0%). Compared with placebo, Vitamin D was not associated with significant reduction of cancer incidence (RR: 0.96; 95% CI: 0.86-1.07; P = 0.46; I2= 31%). Conclusions: Our study highlights that the use of Vitamin D supplementation for primary prevention of cancer is important as it does decrease cancer-related mortality once cancer is diagnosed, however it has no role or effect on cancer incidence.
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Affiliation(s)
- Varun Samji
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Tarek Haykal
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Yazan Zayed
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | | | - Michelle Obeid
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Babikir Kheiri
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Sunil Badami
- Hurley Medical Center/Michigan State University, Flint, MI
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90
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Sidahmed S, Abdalla A, Kheiri B, Bala A, Salih M, Kafri Z, Bachuwa G. Anticoagulants for the treatment of venous thromboembolism in patients with cancer: An updated pairwise and network meta-analysis of randomized trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14692 Background: Cancer-associated venous thromboembolism (VTE) is common. Although low molecular weight heparin (LMWH) is the standard therapy in this setting, little is known with regard to non-vitamin K antagonist oral anticoagulants (NOACs). Therefore, we thought about evaluating the safety and efficacy of various anticoagulants in this vulnerable population. Methods: Electronic database search was conducted to identify randomized clinical trials (RCTs) that compared LMWH, NOACs, and/or vitamin-K-antagonists (VKA) in cancer patients. We performed frequentist direct and Bayesian network meta-analysis using random-effects model to calculate odds ratios (ORs), 95% confidence intervals (CIs), and 95% credible intervals (CrIs). The primary outcome was VTE (pulmonary embolism and deep-vein thrombosis) recurrence. Secondary outcomes were major bleeding and all-cause mortality. Results: We identified 13 RCTs with 6,595 total patients (mean age 62.4 ± 12.2; 50.4% female; 17.7% hematological malignancies; and 6 months median follow-up). The most common cancer type was colorectal and 48% of the population had metastatic cancer at baseline. NOACs were associated with significantly reduced VTE recurrence compared with VKA (OR = 0.58; 95% CI = 0.40-0.83; P < 0.01; number needed to treat [NNT] = 40) and LMWH (OR = 0.46; 95% CI = 0.25-0.85; P = 0.01; NNT = 20). LMHW was associated with significantly reduced VTE recurrence compared with VKA (OR = 0.52; 95% CI = 0.39-0.71; P < 0.01; NNT = 18). NOACs were associated with significantly reduced major bleeding compared with VKA (OR = 0.56; 95% CI = 0.35-0.91; P = 0.02; NNT = 64). There was no significant difference identified between the anticoagulant groups in regard to all-cause mortality. Conclusions: Among cancer patients with VTE, NOACs were associated with significantly reduced VTE recurrence compared to LMWH and VKA, and significantly reduced major bleeding compared with VKA. LMWH was associated with significantly reduced VTE recurrence compared with VKA.
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Affiliation(s)
| | | | - Babikir Kheiri
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Areeg Bala
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | - Zyad Kafri
- St. John Hospital and Medical Center, Detroit, MI
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91
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Barbarawi M, Zayed Y, Kheiri B, Gakhal I, Barbarawi O, Bala A, Alabdouh A, Abdalla A, Haykal T, Goranta S, Bachuwa G, Katato K. The role of anticoagulants for the primary prophylaxis of venous thromboembolism in patients with malignancy: A systematic review and meta-analysis of randomized controlled trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14691 Background: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in cancer patients. Despite this, pharmacologic prophylaxis for the primary prevention of VTE is not offered for most medical oncology patients, likely due to the competing risk of bleeding. Recent trials may offer new insight into the role of anticoagulants for the prevention of cancer associated thrombosis (CAT). Accordingly, we conducted a meta-analysis of randomized controlled trials (RCTs) that evaluated anticoagulants for the primary prophylaxis of VTE in cancer patients. Methods: A literature search of Pubmed/MEDLINE, Embase, and Cochrane library was done by two investigators. All RCTs that used anticoagulant in cancer patients for primary prevention of VTE were included. The primary outcomes were VTE events and all-cause mortality; VTE related mortality and major bleeding were secondary outcomes. A random effects model was used to report the risk ratios (RR) with 95% confidence intervals (CIs), and odds ratios (ORs) with Bayesian 95% credible intervals for both direct and network meta-analysis, respectively. Results: Twenty-four RCTs were included with a total of 13,338 patients (7,197 received anticoagulants and 6,141 received placebo). Of these trials, 19 used low-molecular weight heparin (LMWH), 3 used direct oral anticoagulants (DOACs), 2 used warfarin, and 1 used heparin. Mean age ranged between 54.6 to 68.1 years, with 50.5% male. Compared with placebo, LMWH or DOACs were associated with reduced VTE events (RR 0.58; 95% CI 0.48-0.69, p < 0.001) and (RR 0.39; 95% CI 0.24-0.63, p < 0.001), respectively. LMWH compared with placebo was associated with decreased VTE, and all-cause mortality (P < 0.05). While DOACs was associated with decreased PE events only compared with placebo (RR 0.28; 95% CI 0.11-0.71, P = 0.008). Regarding the safety outcome, LMWH and DOACs were associated with an increased risk of major bleeding compared with placebo, but this did not reach statistical significance in this study (RR 1.26; 95% CI 0.92-1.74, p = 0.16 and RR 1.76; 95% CI 0.83-3.73, p = 0.14). Results regarding VTE events and major bleeding were consistent in both lung and pancreatic cancers. Conclusions: Both LMWH and DOACs were associated with a lower number of VTE events compared with placebo. However, this potentially protective effect must be balanced against a possible increased risk of bleeding for some patients.
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Affiliation(s)
| | - Yazan Zayed
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Babikir Kheiri
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | | | - Areeg Bala
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | | | - Tarek Haykal
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Sowmya Goranta
- Hurley Medical Center/Michigan State University, Flint, MI
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92
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Biedny A, Chahine A, Abdalla A, Sidahmed S, Kheiri B, Kafri Z, Hadid TH. Combined BRAF and MEK Inhibition in Patients with unresectable or metastatic cutaneous melanoma: A meta-analysis of randomized controlled trials. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e21030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21030 Background: Malignant melanoma is a dangerous disease with increasing incidence. Over the past several years, medical advancements have allowed for markedly improved therapeutic options. In patients with BRAF V600E or V600K mutations, the use of various BRAF inhibitors in combination with MEK inhibitors have been approved for stage III unresectable and metastatic disease. Therefore, we aimed to evaluate the efficacy and safety of this combination in comparison to a single agent BRAF inhibitor. Methods: A comprehensive electronic database search was conducted for all randomized controlled trials (RCTs) comparing the clinical outcomes of combination BRAF inhibitor and MEK inhibitor versus BRAF inhibitor alone in patients with unresectable stage III or stage IV BRAF-mutated malignant melanoma. The primary outcome was progression-free survival (PFS). Secondary outcomes included overall survival (OS), overall response, and various selected adverse events. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up period. Results: We included five RCTs with 2,113 total patients, with a mean age of 55.5 years and 56.1% male. The combination therapy of BRAF and MEK inhibitors showed superior results with regard to PFS (HR 0.57; 95% CI: 0.50-0.67; p < 0.001), OS (HR 0.69; 95% CI: 0.61-0.78; p < 0.001), and overall response (HR 1.32; 95% CI: 1.23-1.43; p < 0.001) when compared to BRAF inhibitor alone. Additionally, patients treated with combination therapy had a lower incidence of cutaneous squamous cell carcinoma (Risk Ratio: 0.22; 95% CI: 0.10-0.47; p < 0.001) and arthralgia (Risk Ratio 0.34; 95% CI: 0.15-0.74; p < 0.001). Patients who received combination therapy, however, had a higher incidence of diarrhea (risk ratio 2.53; 95% CI: 1.05-6.09; p = 0.04) and pyrexia (risk ratio 4.98; 95% CI: 2.27-10.92; p < 0.001). Conclusions: For patients with unresectable stage III malignant melanoma or metastatic malignant melanoma, combination therapy with BRAF inhibitor and MEK inhibitor was associated with superior PFS, OS, overall response, and lower incidence of cutaneous squamous cell carcinoma and arthralgia compared with BRAF inhibitor alone. The combination therapy, however, was associated with a higher incidence of diarrhea and pyrexia.
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Affiliation(s)
| | - Adam Chahine
- Hurley Medical Center/Michigan State University, Flint, MI
| | | | | | - Babikir Kheiri
- Hurley Medical Center/Michigan State University, Flint, MI
| | - Zyad Kafri
- St. John Hospital and Medical Center, Detroit, MI
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93
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Kheiri B, Osman M, Elounais F, Alnimer Y, Owda AK, Modawi I, Towfiq B. A case report of double negative anti-GBM disease. Oxf Med Case Reports 2019; 2019:omy124. [PMID: 31049208 PMCID: PMC6487995 DOI: 10.1093/omcr/omy124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/20/2018] [Accepted: 11/14/2018] [Indexed: 11/14/2022] Open
Abstract
Goodpasture's disease is a life-threatening autoimmune disease that can lead to end stage renal disease and death. We report a case of 61-year-old female who presented with deteriorating renal function. Initial laboratory investigations were negative for autoimmune antibodies including negative anti-neutrophilic cytoplasm antibodies and anti-glomerular basement membrane (anti-GBM) antibodies using both enzyme-linked immunosorbent assay and indirect immunofluorescence. However, renal biopsy was positive for linear IgG staining. Despite starting plasmapheresis and corticosteroids treatment, her renal functions continued to deteriorate and she was started on regular hemodialysis. This case highlights the challenging presentation and diagnosis of anti-GBM disease, which requires a high clinical suspicion necessarily for early diagnosis and treatment to improve survival rates.
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Affiliation(s)
- Babikir Kheiri
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Mohammed Osman
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Farah Elounais
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Yanal Alnimer
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ali K Owda
- Department of Nephrology, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Imad Modawi
- Department of Nephrology, Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Basim Towfiq
- Internal Medicine Department, Hurley Medical Center/Michigan State University, Flint, MI, USA
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94
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Zayed Y, Barbarawi M, Kheiri B, Haykal T, Chahine A, Rashdan L, Hamid K, Sundus S, Banifadel M, Aburahma A, Bachuwa G, Chandran A. Triple versus dual inhaler therapy in moderate-to-severe COPD: A systematic review and meta-analysis of randomized controlled trials. Clin Respir J 2019; 13:413-428. [PMID: 30947394 DOI: 10.1111/crj.13026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/21/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Treatment of chronic obstructive pulmonary disease (COPD) is evolving specially with triple inhaler therapy. OBJECTIVES To perform a meta-analysis to ascertain the safety and efficacy of triple inhaler therapy consisting of an inhaled-glucocorticoid (ICS), long-acting muscarinic antagonist (LAMA) and long-acting beta2-agonist (LABA) when compared with dual therapy (ICS-LABA or LAMA-LABA). METHODS We performed an electronic database search to include randomized controlled trials (RCTs) comparing between triple and dual inhalers. Pooled rate-ratio (RR) or odds-ratio (OR) for dichotomous data and weighted mean difference (MD) for continuous data were calculated with their corresponding 95% confidence interval (CI). RESULTS Our study included 12 RCTs totaling 19,322 patients, mean age of 65 ± 8.2 years and 68.2% were male. Pooled analysis demonstrated a significant reduction in moderate-to-severe COPD exacerbations with triple therapy (RR 0.75; 95% CI 0.69-0.83; P < 0.01). Additionally, triple therapy caused significant increase in trough FEV1 (MD 0.09 L; 95% CI 0.07-0.12; P < 0.01), significant reduction in the mean St. George's Respiratory Questionnaire (SGRQ) score (MD -1.67; 95% CI -2.02- -1.31; P < 0.01), and more patients experienced ≥ 4 points reduction of SGRQ score (OR 1.27; 95% CI 1.19-1.35; P < 0.01). Triple therapy was associated with an increased risk of pneumonia when compared to LABA/LAMA (OR 1.25; 95% 1.03-1.97; P = 0.03) but there were no significant differences in other adverse events between triple and dual inhalers. CONCLUSIONS Among patients with moderate-to-severe COPD, triple inhaler therapy was associated with a reduction of moderate-to-severe COPD exacerbations, improved lung function and improved quality of life when compared to dual inhaler therapy but with an increased pneumonia risk.
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Affiliation(s)
- Yazan Zayed
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Mahmoud Barbarawi
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Tarek Haykal
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Adam Chahine
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Laith Rashdan
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Kewan Hamid
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Saira Sundus
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Momen Banifadel
- Internal Medicine Department, University of Toledo, Toledo, Ohio
| | - Ahmed Aburahma
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, Michigan
| | - Arul Chandran
- Pulmonary and Critical Care Department, Hurley Medical Center, Michigan State University, Flint, Michigan
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95
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Zayed Y, Banifadel M, Barbarawi M, Kheiri B, Chahine A, Rashdan L, Haykal T, Samji V, Armstrong E, Bachuwa G, Al-Sanouri I, Seedahmed E, Hernandez DA. Noninvasive Oxygenation Strategies in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Pairwise and Network Meta-Analysis of Randomized Controlled Trials. J Intensive Care Med 2019; 35:1216-1225. [PMID: 31046545 DOI: 10.1177/0885066619844713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Acute hypoxemic respiratory failure (AHRF) is a leading cause of intensive care unit (ICU) admission among immunocompromised patients. Invasive mechanical ventilation is associated with increased morbidity and mortality. OBJECTIVE To evaluate the efficacy of various oxygenation strategies including noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and conventional oxygen therapy in immunocompromised patients with AHRF. METHODS Electronic databases including PubMed, Embase, and the Cochrane Library were reviewed from inception to December 2018. We included all randomized controlled trials (RCTs) comparing different modalities of initial oxygenation strategies in immunocompromised patients with AHRF. Our primary outcome was the need for intubation and invasive mechanical ventilation while secondary outcomes were ICU acquired infections and short- and long-term mortality. Data were extracted separately and independently by 2 reviewers. We performed a Bayesian network meta-analysis to calculate odds ratio (OR) and Bayesian 95% credible intervals (CrIs). RESULTS Nine RCTs were included (1570 patients, mean age 61.1 ± 13.8 years with 64% male). Noninvasive ventilation was associated with a significantly reduced intubation rate compared with standard oxygen therapy (OR: 0.53; 95% CrI: 0.26-0.91). There were no significant reductions of intubation between NIV versus HFNC (OR: 0.83; 95% CrI: 0.35-2.11) or HFNC versus standard oxygen therapy (OR: 0.65; 95% CrI: 0.26-1.24). There were no significant differences between all groups regarding short-term (28-day or ICU) mortality or long-term (90-day or hospital) mortality or ICU-acquired infections (P > 0.05). CONCLUSION Among immunocompromised patients with AHRF, NIV was associated with a significant reduction of intubation compared with standard oxygen therapy. There were no significant differences among all oxygenation strategies regarding mortality and ICU-acquired infections.
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Affiliation(s)
- Yazan Zayed
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Momen Banifadel
- Internal Medicine Department, 89021University of Toledo, Toledo, OH, USA
| | - Mahmoud Barbarawi
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Babikir Kheiri
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Adam Chahine
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Laith Rashdan
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Tarek Haykal
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Varun Samji
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Emily Armstrong
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ghassan Bachuwa
- Internal Medicine Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Ibrahim Al-Sanouri
- Pulmonary and Critical Care Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Elfateh Seedahmed
- Pulmonary and Critical Care Department, 3361Hurley Medical Center/Michigan State University, Flint, MI, USA
| | - Dawn-Alita Hernandez
- Pulmonary and Critical Care Department, 89021University of Toledo, Toledo, OH, USA
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Zayed Y, Barbarawi M, Kheiri B, Banifadel M, Haykal T, Chahine A, Rashdan L, Aburahma A, Bachuwa G, Seedahmed E. Haloperidol for the management of delirium in adult intensive care unit patients: A systematic review and meta-analysis of randomized controlled trials. J Crit Care 2019; 50:280-286. [DOI: 10.1016/j.jcrc.2019.01.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/10/2018] [Accepted: 01/11/2019] [Indexed: 12/23/2022]
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Haykal T, Kheiri B, Zayed Y, Barbarawi M, Miran MS, Chahine A, Katato K, Bachuwa G. Aspirin for venous thromboembolism prophylaxis after hip or knee arthroplasty: An updated meta-analysis of randomized controlled trials. J Orthop 2019; 16:312-319. [PMID: 30976146 DOI: 10.1016/j.jor.2019.02.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/22/2019] [Indexed: 11/18/2022] Open
Abstract
Background Patients who undergo knee or hip arthroplasty are at a significant risk of venous thromboembolism (VTE) development (pulmonary embolism and/or deep-vein thrombosis). Many different thromboprophylactic strategies have been used for the prevention of VTE in these patients with different outcomes. Therefore, our aim was to evaluate the efficacy and safety of aspirin prophylaxis when compared with placebo or anticoagulants in this population of patients. Methods A comprehensive electronic database search was conducted for all randomized controlled trials (RCTs) comparing the clinical outcomes of aspirin versus placebo or anticoagulants for the prevention of VTE after knee or hip arthroplasty. The primary outcome was VTE incidence. Secondary outcomes included any bleeding, major bleeding and mortality. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest possible follow-up period. Results We included 13 RCTs with a total of 20,115 patients with a mean age of 67.15 ± 9.54 and 24.39% males. Aspirin was found to be associated with a non-significantly reduced VTE events compared with other thromboprophylactic methods (RR 0.87; 95% CI: 0.61-1.23; P = 0.43). Compared with placebo, aspirin was associated with significant reduction of VTE (RR 0.65; 95% CI: 0.47-0.89; P = 0.008). There were no significant differences in the clinical outcomes between all groups with regard to mortality (RR 0.98; 95% CI: 0.86-1.11; P = 0.72), major bleeding events (RR 0.96; 95% CI: 0.50-1.84; P = 0.91), and any bleeding events (RR: 1.09; 95% CI: 0.82-1.44; P = 0.56). Conclusion Among patients who underwent knee or hip arthroplasty, aspirin prophylaxis was found to be associated with similar efficacy and safety outcomes when compared with anticoagulants. When compared with placebo, aspirin prophylaxis was associated with significantly reduced VTE and a comparable safety profile.
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Affiliation(s)
- Tarek Haykal
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Babikir Kheiri
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Yazan Zayed
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Mahmoud Barbarawi
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Muhammad Shah Miran
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Adam Chahine
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Khalil Katato
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
- Genessee Hematology & Oncology, PC, Flint, MI, USA
| | - Ghassan Bachuwa
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
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Haykal T, Kheiri B, Zayed Y, Barbarawi M, Miran MS, Chahine A, Katato K, Bachuwa G. Aspirin for venous thromboembolism prophylaxis after hip or knee arthroplasty: An updated meta-analysis of randomized controlled trials. J Orthop 2019; 16:294-302. [PMID: 30976143 DOI: 10.1016/j.jor.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Patients who undergo knee or hip arthroplasty are at a significant risk of venous thromboembolism (VTE) development (pulmonary embolism and/or deep-vein thrombosis). Many different thromboprophylactic strategies have been used for the prevention of VTE in these patients with different outcomes. Therefore, our aim was to evaluate the efficacy and safety of aspirin prophylaxis when compared with placebo or anticoagulants in this population of patients. Methods A comprehensive electronic database search was conducted for all randomized controlled trials (RCTs) comparing the clinical outcomes of aspirin versus placebo or anticoagulants for the prevention of VTE after knee or hip arthroplasty. The primary outcome was VTE incidence. Secondary outcomes included any bleeding, major bleeding and mortality. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest possible follow-up period. Results We included 13 RCTs with a total of 20,115 patients with a mean age of 67.15 ± 9.54 and 24.39% males. Aspirin was found to be associated with a non-significantly reduced VTE events compared with other thromboprophylactic methods (RR 0.87; 95% CI: 0.61-1.23; P = 0.43). Compared with placebo, aspirin was associated with significant reduction of VTE (RR 0.65; 95% CI: 0.47-0.89; P = 0.008). There were no significant differences in the clinical outcomes between all groups with regard to mortality (RR 0.98; 95% CI: 0.86-1.11; P = 0.72), major bleeding events (RR 0.96; 95% CI: 0.50-1.84; P = 0.91), and any bleeding events (RR: 1.09; 95% CI: 0.82-1.44; P = 0.56). Conclusion Among patients who underwent knee or hip arthroplasty, aspirin prophylaxis was found to be associated with similar efficacy and safety outcomes when compared with anticoagulants. When compared with placebo, aspirin prophylaxis was associated with significantly reduced VTE and a comparable safety profile.
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Affiliation(s)
- Tarek Haykal
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Babikir Kheiri
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Yazan Zayed
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Mahmoud Barbarawi
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Muhammad Shah Miran
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Adam Chahine
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Khalil Katato
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Genessee Hematology & Oncology, PC, Flint, MI, USA
| | - Ghassan Bachuwa
- Hurley Medical Center, Department of Internal Medicine, Flint, MI, USA
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
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Haykal T, Kheiri B, Samji V, Zayed Y, Al-Dulaimi R, Gakhal I, Bala A, Sotzen J, Abdalla A, Bachuwa G. CLO19-035: Safety Profile and Adverse Events of Sunitinib as a First-Line Treatment for Advanced/Metastatic Clear-Cell Renal Cell Carcinoma: Pooled Analysis of Randomized Controlled Trials. J Natl Compr Canc Netw 2019. [DOI: 10.6004/jnccn.2018.7229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Metastatic clear-cell renal cell carcinoma (RCC) is largely incurable, and its treatment remains challenging. Sunitinib, a tyrosine kinase inhibitor, is one of the current standard-of-care options for treatment-naïve patients with metastatic RCC. Despite the proven efficacy of sunitinib, prolonged treatment with some tyrosine kinase inhibitors (TKIs) has been associated with significant adverse events (AEs). Therefore, we aimed to calculate the exact prevalence of all sunitinib-related AEs in a pooled analysis from all available randomized controlled trials (RCTs). Methods: A comprehensive electronic database search was conducted for all RCTs comparing the clinical outcomes and adverse events of sunitinib versus all other available treatments for treatment-naïve advanced/metastatic clear-cell renal cell carcinoma. We then calculated the pooled prevalence of the most common reported side effects of sunitinib. All statistical analyses were performed using R Statistical Software v3.4.0 (R Foundation, Vienna, Austria). Results: We included 8 RCTs, with a total of 4,106 patients. The mean age was 62, with 66.44% males. Any grade AEs were reported in 72% of patients with the following frequencies: fatigue, 44%; diarrhea, 38%; nausea, 31%; hand-foot syndrome, 30%; hypertension, 27%; dysgeusia, 25%; hypothyroidism, 25%; cconstipation, 20%; stomatitis, 20%; inflammation of the mucosa, 18%; dyspepsia, 16%; vomiting, 14%; rash, 12%; asthenia, 11%; and epistaxis, 10%. Grade 3 (severe) AEs were reported in 52% of patients with the following frequencies: hypertension, 9%; fatigue, 8%; hand-foot syndrome, 5%; asthenia, 5%; diarrhea, 4%; and inflammation of the mucosa, 2%. Laboratory abnormalities were also reported as follows: increased AST, 7%; increased lipase, 6%; neutropenia, 6%; thrombocytopenia, 6%; hypophosphatemia, 5%; lymphocytopenia, 5%; anemia, 4%; and leukopenia, 3%. Conclusion: Despite sunitinib being one of the current standard treatments for patients with metastatic/advanced clear-cell RCC, its safety profile is concerning, with a high prevalence of reported dangerous side effects. These findings underscore the importance of the emergence of newer drugs and treatment plans for patients with metastatic RCC, not only to achieve similar or better clinical outcomes but also to decrease the burden of adverse events.
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Affiliation(s)
- Tarek Haykal
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Babikir Kheiri
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Varun Samji
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Yazan Zayed
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Ragheed Al-Dulaimi
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Inderdeep Gakhal
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Areeg Bala
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | - Jason Sotzen
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
| | | | - Ghassan Bachuwa
- aHurley Medical Center, Flint, MI
- bMichigan State University, East Lansing, MI
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Barbarawi M, Kheiri B, Zayed Y, Rashdan L, Gakhal I, Barbarawi O, Bachuwa G, Alkotob ML, Bhatt DL. COMPARISON OF PERCUTANEOUS CORONARY INTERVENTION VERSUS OPTIMAL MEDICAL THERAPY IN THE TREATMENT OF CORONARY TOTAL OCCLUSION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31887-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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