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Marine-derived n-3 fatty acids therapy for stroke
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-certainty evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functional outcome might consider starting the intervention as early as possible after the event, as well as using standardised, clinically relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and m...
Source: Cochrane Database of Systematic Reviews - June 29, 2022 Category: General Medicine Authors: Celia Gabriela Alvarez Campano Mary Joan Macleod Lorna Aucott Frank Thies Source Type: research

Antiplatelet agents for chronic kidney disease
CONCLUSIONS: Antiplatelet agents probably reduced myocardial infarction and increased major bleeding, but do not appear to reduce all-cause and cardiovascular death among people with CKD and those treated with dialysis. The treatment effects of antiplatelet agents compared with each other are uncertain.PMID:35224730 | DOI:10.1002/14651858.CD008834.pub4
Source: Cochrane Database of Systematic Reviews - February 28, 2022 Category: General Medicine Authors: Patrizia Natale Suetonia C Palmer Valeria M Saglimbene Marinella Ruospo Mona Razavian Jonathan C Craig Meg J Jardine Angela C Webster Giovanni Fm Strippoli Source Type: research

Transfusion thresholds for guiding red blood cell transfusion
CONCLUSIONS: Transfusion at a restrictive haemoglobin concentration decreased the proportion of people exposed to RBC transfusion by 41% across a broad range of clinical contexts. Across all trials, no evidence suggests that a restrictive transfusion strategy impacted 30-day mortality, mortality at other time points, or morbidity (i.e. cardiac events, myocardial infarction, stroke, pneumonia, thromboembolism, infection) compared with a liberal transfusion strategy. Despite including 17 more randomised trials (and 8846 participants), data remain insufficient to inform the safety of transfusion policies in important and sele...
Source: Cochrane Database of Systematic Reviews - December 21, 2021 Category: General Medicine Authors: Jeffrey L Carson Simon J Stanworth Jane A Dennis Marialena Trivella Nareg Roubinian Dean A Fergusson Darrell Triulzi Carolyn Dor ée Paul C H ébert Source Type: research

Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis.
CONCLUSIONS: Very low- to moderate-certainty evidence suggests no meaningful difference in efficacy outcomes between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists following percutaneous coronary interventions (PCI) in people with non-valvular atrial fibrillation. NOACs probably reduce the risk of recurrent hospitalisation for adverse events compared with vitamin K antagonists. Low- to moderate-certainty evidence suggests that dabigatran may reduce the rates of major and non-major bleeding, and apixaban and rivaroxaban probably reduce the rates of non-major bleeding compared with vitamin K an...
Source: Cochrane Database of Systematic Reviews - December 18, 2019 Category: General Medicine Authors: Al Said S, Alabed S, Kaier K, Tan AR, Bode C, Meerpohl JJ, Duerschmied D Tags: Cochrane Database Syst Rev Source Type: research

Marine-derived n-3 fatty acids therapy for stroke.
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention.Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of ad...
Source: Cochrane Database of Systematic Reviews - June 25, 2019 Category: General Medicine Authors: Alvarez Campano CG, Macleod MJ, Aucott L, Thies F Tags: Cochrane Database Syst Rev Source Type: research

Direct oral anticoagulants versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation patients with chronic kidney disease.
CONCLUSIONS: Our findings indicate that DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding. The major limitation is that the results of this study chiefly reflect CKD stage G3. Application of the results to CKD stage G4 patients requires additional investigation. Furthermore, we could not assess CKD stage G5 patients. Future reviews should assess participants at more advanced CKD stages. Additio...
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Kimachi M, Furukawa TA, Kimachi K, Goto Y, Fukuma S, Fukuhara S Tags: Cochrane Database Syst Rev Source Type: research

Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock.
CONCLUSIONS: Available evidence suggests that IABP may have a beneficial effect on some haemodynamic parameters. However, this did not result in survival benefits so there is no convincing randomised data to support the use of IABP in infarct-related cardiogenic shock. PMID: 25812932 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - April 2, 2015 Category: Journals (General) Authors: Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, Thiele H, Werdan K, Zeymer U, Prondzinsky R Tags: Cochrane Database Syst Rev Source Type: research

Parenteral anticoagulation in ambulatory patients with cancer.
CONCLUSIONS: Heparin may have a small effect on mortality at 12 months and 24 months. It is associated with a reduction in venous thromboembolism and a likely increase in minor bleeding. Future research should further investigate the survival benefit of different types of anticoagulants in patients with different types and stages of cancer. The decision for a patient with cancer to start heparin therapy for survival benefit should balance the benefits and downsides, and should integrate the patient's values and preferences. PMID: 25491949 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 10, 2014 Category: Journals (General) Authors: Akl EA, Kahale LA, Ballout RA, Barba M, Yosuico VE, van Doormaal FF, Middeldorp S, Bryant A, Schünemann H Tags: Cochrane Database Syst Rev Source Type: research

Thrombolysis for acute ischaemic stroke.
CONCLUSIONS: Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial haemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up). Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracrani...
Source: Cochrane Database of Systematic Reviews - August 3, 2014 Category: Journals (General) Authors: Wardlaw JM, Murray V, Berge E, Del Zoppo GJ Tags: Cochrane Database Syst Rev Source Type: research

Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.
CONCLUSIONS: DTIs were as efficacious as VKAs for the composite outcome of vascular death and ischaemic events and only the dose of dabigatran 150 mg twice daily was found to be superior to warfarin. DTIs were associated with fewer major haemorrhagic events, including haemorrhagic strokes. Adverse events that led to discontinuation of treatment occurred more frequently with the DTIs. We detected no difference in death from all causes. PMID: 24677203 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 27, 2014 Category: Journals (General) Authors: Salazar CA, Del Aguila D, Cordova EG Tags: Cochrane Database Syst Rev Source Type: research

Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters.
CONCLUSIONS: We found no significant effects of systemic treatments compared with no intervention in preventing (a)symptomatic VTE in paediatric oncology patients with CVCs. However, this could be a result of the low number of included participants, which resulted in low power. In one CCT, which compared one systemic treatment with another systemic treatment, we identified a significant reduction in symptomatic VTE with the addition of LMWH to AT supplementation.All studies investigated the prevalence of major and/or minor bleeding episodes, and none found a significant difference between study groups. None of the studies ...
Source: Cochrane Database of Systematic Reviews - September 11, 2013 Category: Journals (General) Authors: Schoot RA, Kremer LC, van de Wetering MD, van Ommen CH Tags: Cochrane Database Syst Rev Source Type: research

Tranexamic acid for reducing mortality in emergency and urgent surgery.
CONCLUSIONS: There is evidence that tranexamic acid reduces blood transfusion in patients undergoing emergency or urgent surgery. There is a need for a large pragmatic clinical trial to assess the effects of routine use of tranexamic acid on mortality in a heterogeneous group of urgent and emergency surgical patients. PMID: 23440847 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - March 2, 2013 Category: Journals (General) Authors: Perel P, Ker K, Morales Uribe CH, Roberts I Tags: Cochrane Database Syst Rev Source Type: research