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Wang S, Liu Y, Wang L, Zuo H, Tian Y, Wang Y, Yin D, Zhang H, Tian Y. Optimisation of oral anticoagulants for patients with atrial fibrillation within 12 months after percutaneous coronary intervention: A meta-analysis and systematic review. Int J Cardiol Heart Vasc 2021; 36:100850. [PMID: 34401468 PMCID: PMC8349768 DOI: 10.1016/j.ijcha.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/13/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal antithrombotic strategy, especially regarding oral anticoagulants (OACs) for atrial fibrillation (AF) patients with bleeding and thrombosis risk after percutaneous coronary intervention (PCI), remains unknown. This study explored the optimal oral anticoagulants for AF patients after PCI using a meta-analysis. METHODS Randomised controlled trials were identified from PubMed, Embase, and the Cochrane Library through December 2020. Risk ratios, 95% confidence intervals, and random-effects models were used to compare different antithrombotic strategies through network meta-analysis, and the combination of antithrombotic agents was ranked according to the surface under the cumulative ranking curve and rankograms. Interval plots were drawn to observe pairwise comparisons between the different strategies. RESULTS Five studies of 11,532 patients were included. Factor IIa inhibitor 110 mg bid plus a P2Y12 inhibitor had the greatest advantage for reducing Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding; Factor Xa inhibitor plus a P2Y12 inhibitor had the greatest advantage for reducing International Society on Thrombosis and Hemostasis major bleeding. For patients at risk of stroke plus all-cause death, factor IIa inhibitor 150 mg bid plus a P2Y12 inhibitor should be prioritised, and for those at risk of myocardial infarction and stent thrombosis, vitamin K antagonists plus a P2Y12 inhibitor were preferred. CONCLUSION Factor IIa inhibitor 110 mg, factor IIa inhibitor 150 mg, factor Xa inhibitor and vitamin K antagonists should be selected in different situations.
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Key Words
- 95% CI, 95% confidence intervals
- AF, Atrial fibrillation
- Antithrombotic therapy
- Atrial fibrillation
- DAT, Oral anticoagulants plus single antiplatelet therapy
- IIa, Factor IIa
- ISTH, International Society on Thrombosis and Hemostasis
- MI, Myocardial infarction
- NOACs, Novel oral anticoagulants
- OACs, Oral anticoagulants
- Oral anticoagulant
- PCI, Percutaneous coronary intervention
- Percutaneous coronary intervention
- RR, Risk ratios
- SD, Standard deviation
- SUCRA, Surface under the cumulative ranking curve
- TAT, Vitamin K antagonist plus a P2Y12 inhibitor and aspirin
- TIMI, Thrombolysis In Myocardial Infarction
- VKA, Vitamin K antagonist
- Xa, Factor Xa
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Affiliation(s)
- Shuo Wang
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Ying Liu
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Linxin Wang
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Haiqi Zuo
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Yanfeng Tian
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Yimeng Wang
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
| | - Dechun Yin
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Haiyu Zhang
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
| | - Ye Tian
- Department of Pathophysiology and Key Laboratory of Cardiovascular Pathophysiology, Harbin Medical University, Key Laboratory of Cardiovascular Research (Harbin Medical University), Ministry of Education, Harbin 150086, PR China
- Heilongjiang Academy of Medical Sciences, Harbin, China
- Department of Cardiology, The First Affiliated Hospital, Cardiovascular Institute, Harbin Medical University, Harbin 150001, PR China
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Chen JJ, Chen YW, Zeng BY, Hung CM, Zeng BS, Stubbs B, Carvalho AF, Thompson T, Roerecke M, Su KP, Tu YK, Wu YC, Smith L, Chen TY, Lin PY, Liang CS, Hsu CW, Hsu SP, Kuo HC, Wu MK, Tseng PT. Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: A network meta-analysis of randomised controlled trials. EClinicalMedicine 2021; 39:101080. [PMID: 34611615 PMCID: PMC8478678 DOI: 10.1016/j.eclinm.2021.101080] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although tinnitus has a prevalence between 20 and 42.8%, the currently recommended management for tinnitus, such as tinnitus support and psychologic therapies, are relatively time-consuming and expensive. Several new pharmacologic treatments designed for tinnitus patients without specific origin had been developed but their efficacy remains unclear. METHODS The current Network Meta-Analysis (NMA) of randomised controlled trials (RCTs) was conducted to evaluate the efficacy of different pharmacologic treatments for tinnitus management in tinnitus patients without specific or treatable origin (i.e. primary tinnitus). Databases were searched from inception to April 5th, 2021. All network meta-analytic procedures were conducted under the frequentist model. We calculated the effect size of outcomes with different rating scales with standardized mean difference. PROSPERO registration: CRD42020177742. FINDINGS Overall, 36 RCTs were included with 2,761 participants. The main results revealed that pharmacologic interventions with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) and those with anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) were associated with superior improvement in tinnitus severity and response rate compared to placebo/control. Oral amitriptyline were associated with the highest improvement in tinnitus severity and the fourth highest response rate. None of the investigated interventions was associated with different changes in quality of life compared to placebo/control. All the investigated treatments were associated with similar drop-out rate to placebo/control. INTERPRETATION The current NMA suggests a potential role for treatments with brain-acting effect (for example, amitriptyline, acamprosate, and gabapentin) or anti-inflammation/anti-oxidant effect (for example, intra-tympanic dexamethasone injection plus oral melatonin) as the preferable effective treatments for tinnitus without specific or treatable origin. FUNDING none.
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Key Words
- 95%CIs, 95% confidence intervals
- ACA, Acamprosate
- ALP, Alprazolam
- ALVitC, Alpha-lipoic acid plus vitamin C
- AMI, Amitriptyline
- Bet, Betahistine
- CHL, Chlorpheniramine
- CLES, Common language effect size
- CLO, Clonazepam
- Car, Carbamazepine
- ClD, Clonazepam plus deanxit
- DEX, Intra-tympanic dexamethasone injection
- DeGin, Intra-tympanic dexamethasone injection plus ginkgo biloba
- DeLid, Intra-tympanic dexamethasone injection plus lidocaine
- DeMel, Intra-tympanic dexamethasone injection plus melatonin
- GABA, gamma-Aminobutyric acid
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- GaLid, gabapentin plus intradermal lidocaine injection
- Gab, gabapentin
- Gin, ginkgo biloba
- KRG, Korean red ginseng
- MIS, Misoprostol
- MeSul, Melatonin and sulodexide
- Mel, Melatonin alone
- Met, Intra-tympanic methylprednisolone injection
- NER, Neramexane
- NMA, Network meta-analysis
- NOR, Nortriptyline
- OXC, Oxcarbazepine
- Ozone, Ozone exposure
- PAR, Paroxetine
- PIR, Piribedil
- PLA, placebo
- PRA, Pramipexole
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PaVitE, papaverine hydrochloride plus vitamin E
- Pen, Pentoxifylline
- RCT, Randomised controlled trials
- RR, Rate ratio
- SER, Sertraline
- SMD, Standardized mean difference
- SUCRA, Surface under the cumulative ranking curve
- THI, Tinnitus handicap inventory
- TRA, Trazodone
- TRI, Postaurical subcutaneous triamcinolone injection
- VAR, Vardenafil
- VAS, Visual analogue scale
- VES, Vestipitant
- VePar, Vestipitant and paroxetine
- Zinc, Zinc supplementation
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Affiliation(s)
- Jiann-Jy Chen
- Department of Otorhinolaryngology, E-Da Cancer Hospital, Kaohsiung, Taiwan
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andre F. Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Dalla Lana School of Public Health (DLSPH), University of Toronto, Abbreviation:
| | - Kuan-Pin Su
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology & Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Lee Smith
- The Cambridge Center for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Pin Hsu
- Department of Neurology, E-Da hospital/School of medicine, I-Shou university, Kaohsiung, Taiwan
| | - Hung-Chang Kuo
- Department of Neurology, E-Da hospital/School of medicine, I-Shou university, Kaohsiung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Corresponding author.
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Corresponding author.
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