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Blood transfusion for preventing primary and secondary stroke in people with sickle cell disease.
CONCLUSIONS: The STOP trial demonstrated a significantly reduced risk of stroke in participants with abnormal transcranial Doppler ultrasonography velocities receiving regular blood transfusions. The follow-up trial (STOP 2) indicated that individuals may revert to former risk status if transfusion is discontinued. The degree of risk must be balanced against the burden of chronic transfusions. The combination of hydroxyurea and phlebotomy is not as effective as "standard" transfusion and chelation in preventing secondary stroke and iron overload. Ongoing multicentre trials are investigating the use of chronic transfusion t...
Source: Cochrane Database of Systematic Reviews - November 14, 2013 Category: Journals (General) Authors: Wang WC, Dwan K Tags: Cochrane Database Syst Rev Source Type: research

Cell salvage for minimising perioperative allogeneic blood transfusion in adults undergoing elective surgery
CONCLUSIONS: In some types of elective surgery, cell salvage may reduce the need for and volume of allogeneic transfusion, alongside evidence of no difference in adverse events, when compared to no cell salvage. Further research is required to establish why other surgeries show no benefit from CS, through further analysis of the current evidence. More large RCTs in under-reported specialities are needed to expand the evidence base for exploring the impact of CS.PMID:37681564 | DOI:10.1002/14651858.CD001888.pub5
Source: Cochrane Database of Systematic Reviews - September 8, 2023 Category: General Medicine Authors: Thomas D Lloyd Louise J Geneen Keeley Bernhardt William McClune Scott J Fernquest Tamara Brown Carolyn Dor ée Susan J Brunskill Michael F Murphy Antony Jr Palmer 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

Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis.
CONCLUSIONS: In the CKD setting, there is currently insufficient evidence to suggest the superiority of any ESA formulation based on available safety and efficacy data. Directly comparative data for the effectiveness of different ESA formulations based on patient-centred outcomes (such as quality of life, fatigue, and functional status) are sparse and poorly reported and current research studies are unable to inform care. All proprietary ESAs (epoetin alfa, epoetin beta, darbepoetin alfa, and methoxy polyethylene glycol-epoetin beta) prevent blood transfusions but information for biosimilar ESAs is less conclusive. Compara...
Source: Cochrane Database of Systematic Reviews - December 8, 2014 Category: Journals (General) Authors: Palmer SC, Saglimbene V, Mavridis D, Salanti G, Craig JC, Tonelli M, Wiebe N, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Hydroxyurea (hydroxycarbamide) for sickle cell disease.
CONCLUSIONS: There is evidence to suggest that hydroxyurea is effective in decreasing the frequency of pain episodes and other acute complications in adults and children with sickle cell anaemia of HbSS or HbSβºthal genotypes and in preventing life-threatening neurological events in those with sickle cell anaemia at risk of primary stroke by maintaining transcranial doppler velocities. However, there is still insufficient evidence on the long-term benefits of hydroxyurea, particularly in preventing chronic complications of SCD, recommending a standard dose or dose escalation to maximum tolerated dose. There is also insuf...
Source: Cochrane Database of Systematic Reviews - April 20, 2017 Category: Journals (General) Authors: Nevitt SJ, Jones AP, Howard J Tags: Cochrane Database Syst Rev Source Type: research

Hydroxyurea (hydroxycarbamide) for sickle cell disease
CONCLUSIONS: There is evidence to suggest that hydroxyurea may be effective in decreasing the frequency of pain episodes and other acute complications in adults and children with sickle cell anaemia of HbSS or HbSβºthal genotypes and in preventing life-threatening neurological events in those with sickle cell anaemia at risk of primary stroke by maintaining transcranial Doppler velocities. However, there is still insufficient evidence on the long-term benefits of hydroxyurea, particularly with regard to preventing chronic complications of SCD, or recommending a standard dose or dose escalation to maximum tolerated dose. ...
Source: Cochrane Database of Systematic Reviews - September 1, 2022 Category: General Medicine Authors: Angela E Rankine-Mullings Sarah J Nevitt Source Type: research

Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis
CONCLUSIONS: The comparative effects of different ESAs on blood transfusions, death (any cause and cardiovascular), major cardiovascular events, myocardial infarction, stroke, vascular access thrombosis, kidney failure, fatigue and breathlessness were uncertain.PMID:36791280 | DOI:10.1002/14651858.CD010590.pub3
Source: Cochrane Database of Systematic Reviews - February 15, 2023 Category: General Medicine Authors: Edmund Ym Chung Suetonia C Palmer Valeria M Saglimbene Jonathan C Craig Marcello Tonelli Giovanni Fm Strippoli Source Type: research

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for  hip, pelvic and long bone fractures
CONCLUSIONS: We cannot draw conclusions from the current evidence due to lack of data. Most published studies included in our analyses assessed the use of tranexamic acid (compared to placebo, or using different routes of administration). We identified 27 prospectively registered ongoing RCTs (total target recruitment of 4177 participants by end of 2023). The ongoing trials create six new comparisons: tranexamic acid (tablet + injection) versus placebo; intravenous tranexamic acid versus oral tranexamic acid; topical tranexamic acid versus oral tranexamic acid; different intravenous tranexamic acid dosing regimes; topical ...
Source: Cochrane Database of Systematic Reviews - June 5, 2023 Category: General Medicine Authors: Victoria N Gibbs Rita Champaneria Louise J Geneen Parag Raval Carolyn Dor ée Susan J Brunskill Alex Novak Antony Jr Palmer Lise J Estcourt Source Type: research

Antifibrinolytic drugs for acute traumatic injury.
CONCLUSIONS: TXA safely reduces mortality in trauma patients with bleeding without increasing the risk of adverse events.  TXA should be given as early as possible and within three hours of injury, as further analysis of the CRASH-2 trial showed that treatment later than this is unlikely to be effective and may be harmful. Although there is some promising evidence for the effect of TXA in patients with TBI, substantial uncertainty remains.Two ongoing trials being conducted in patients with isolated TBI should resolve these remaining uncertainties. PMID: 25956410 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 9, 2015 Category: Journals (General) Authors: Ker K, Roberts I, Shakur H, Coats TJ Tags: Cochrane Database Syst Rev Source Type: research

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