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Wang M, Chen Z, Wong M, Thabane L, Mbuagbaw L, Siegal D, Le Gal G, Holbrook A. Are the correct outcomes being measured in studies of oral anticoagulants? A systematic survey. Thromb Res 2021; 201:30-49. [PMID: 33631520 DOI: 10.1016/j.thromres.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/26/2021] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Oral anticoagulant (OAC) intervention trials have typically included clinical event outcomes. However, there is no standard list of outcomes to be used in OAC research. This study aimed to describe and classify the outcomes used in recent prospective clinical studies involving OACs. MATERIALS AND METHODS We searched MEDLINE, EMBASE, and CINAHL databases from January 2009 to July 2019 for prospective studies with an intervention or control group that included one or more oral anticoagulants. We abstracted details about each included study and the outcomes used from the study report and its accompanying protocol. Using the Core Outcome Measures in Effectiveness Trials (COMET) Initiative recommendations, we categorised each outcome into one of five domains (mortality/survival, physiological/clinical, life impact, resource use, and adverse events). Our primary outcome was the prevalence of use of an outcome domain across studies. RESULTS We included 70 prospective studies, including 52 randomized controlled trials and 18 prospective cohort studies. A total of 121 different outcomes were reported. The COMET domains were represented in the 70 studies as follows: mortality (63/70, 90.0%); physiological/clinical domain (70/70, 100%), life impact domain (43/70, 61.4%), resource use domain (26/70, 37.1%), and adverse events domain (55/70, 78.6%). CONCLUSION Outcome reporting in prospective studies of OACs more frequently concentrates on mortality, physiological/clinical domains, and adverse events compared to life impact and resource utilization domains, the latter uncommonly used. A priority for future research includes developing a core outcome set (COS) for OAC research that represents all domains.
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Affiliation(s)
- Mei Wang
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada; Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton L8N 4A6, ON, Canada.
| | - Zhiyuan Chen
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada
| | - Michael Wong
- Bachelor Life Sciences Program, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada; Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton L8N 4A6, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada; Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton L8N 4A6, ON, Canada
| | - Deborah Siegal
- Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada
| | - Gregoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth, Ottawa K1H 8L6, ON, Canada
| | - Anne Holbrook
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada; Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton L8N 4A6, ON, Canada; Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton L8S 4K1, ON, Canada
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Tarasoutchi F, Montera MW, Ramos AIDO, Sampaio RO, Rosa VEE, Accorsi TAD, Santis AD, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PDL, Ávila WS, Paixão MR, Bignoto T, Togna DJD, Mesquita ET, Esteves WADM, Atik F, Colafranceschi AS, Moises VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Junior FSD, Weksler C, Brandão CMDA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MDM, Abizaid A, Ribeiro HB, Bacal F, Rochitte CE, Fonseca JHDAPD, Ghorayeb SKN, Lopes MACQ, Spina SV, Pignatelli RH, Saraiva JFK. Update of the Brazilian Guidelines for Valvular Heart Disease - 2020. Arq Bras Cardiol 2020; 115:720-775. [PMID: 33111877 PMCID: PMC8386977 DOI: 10.36660/abc.20201047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Roney Orismar Sampaio
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Vitor Emer Egypto Rosa
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Antonio de Santis
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - João Ricardo Cordeiro Fernandes
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Lucas José Tachotti Pires
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Guilherme S Spina
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Paulo de Lara Lavitola
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Walkiria Samuel Ávila
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Milena Ribeiro Paixão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tiago Bignoto
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | | | - Fernando Atik
- Fundação Universitária de Cardiologia (FUC), São Paulo, SP - Brasil
| | | | | | | | | | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Carlos Manuel de Almeida Brandão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Robinson Poffo
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | | | - Ricardo Mourilhe-Rocha
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Alexandre Abizaid
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Henrique Barbosa Ribeiro
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - José Francisco Kerr Saraiva
- Sociedade Campineira de Educação e Instrução Mantenedora da Pontifícia Universidade Católica de Campinas, Campinas, SP - Brasil
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Comparative efficacy and safety of warfarin care bundles and novel oral anticoagulants in patients with atrial fibrillation: a systematic review and network meta-analysis. Sci Rep 2020; 10:662. [PMID: 31959803 PMCID: PMC6971267 DOI: 10.1038/s41598-019-57370-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/18/2019] [Indexed: 01/04/2023] Open
Abstract
Warfarin care bundles (e.g. genotype-guided warfarin dosing, patient’s self-testing [PST] or patient’s self-management [PSM] and left atrial appendage closure) are based on the concept of combining several interventions to improve anticoagulation care. NOACs are also introduced for stroke prevention in atrial fibrillation (SPAF). However, these interventions have not been compared in head-to-head trials yet. We did a network meta-analysis based on a systematic review of randomized controlled trials comparing anticoagulant interventions for SPAF. Studies comparing these interventions in adults, whether administered alone or as care bundles were included in the analyses. The primary efficacy outcome was stroke and the primary safety outcome was major bleeding. Thirty-seven studies, involving 100,142 patients were assessed. Compared to usual care, PSM significantly reduced the risk of stroke (risk ratio [RR] 0.24, 95% CI 0.08–0.68). For major bleeding, edoxaban 60 mg (0.80, 0.71–0.90), edoxaban 30 mg (0.48, 0.42–0.56), and dabigatran 110 mg (0.81, 0.71–0.94) significantly reduced the risk of major bleeding compared with usual warfarin care. Cluster rank plot incorporating stroke and major bleeding outcomes indicates that some warfarin care bundles perform as well as NOACs. Both interventions are therefore viable options to be considered for SPAF. Additional studies including head-to-head trials and cost-effectiveness evaluation are still warranted.
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Ambrosi P, Daumas A, Villani P, Giorgi R. Meta-analysis of major bleeding events on aspirin versus vitamin K antagonists in randomized trials. Int J Cardiol 2017; 230:572-576. [DOI: 10.1016/j.ijcard.2016.12.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 11/15/2022]
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Vazquez FJ, Gonzalez JP, LeGal G, Carrier M, Gándara E. Risk of major bleeding in patients receiving vitamin K antagonists or low doses of aspirin. A systematic review and meta-analysis. Thromb Res 2016; 138:1-6. [DOI: 10.1016/j.thromres.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/08/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
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Zhang JT, Chen KP, Zhang S. Efficacy and safety of oral anticoagulants versus aspirin for patients with atrial fibrillation: a meta-analysis. Medicine (Baltimore) 2015; 94:e409. [PMID: 25634169 PMCID: PMC4602973 DOI: 10.1097/md.0000000000000409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to perform a meta-analysis comparing the effectiveness and safety of anticoagulation to antiplatelet therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched for studies published through May 31, 2014. Randomized controlled trials comparing anticoagulants (warfarin) and antiplatelet therapy in patients with AF were included. The primary outcomes were the rates of stroke and systemic embolism. Secondary outcomes included the rates of hemorrhage/major bleeding and death. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Nine reports of 8 trials that enrolled 4363 patients (2169 patients received anticoagulation and 2194 antiplatelet therapy) were included. All of the studies compared adjusted-dose warfarin or with aspirin, and the majority of the patients were >70 years of age. Anticoagulants were titrated to an international normalized ratio (INR) of 2.0 to 4.5, and aspirin was administered at a dosage of 75 to 325 mg/d. Death occurred in 206 participants treated with an anticoagulant and 229 participants treated with antiplatelet therapy. There was no significant difference in the overall stroke rate between the groups (OR = 0.667, 95% CI 0.426-1.045, P = 0.08); however, patients with nonrheumatic AF (NRAF) treated with an anticoagulant had a lower risk of stroke (OR = 0.557, 95% CI 0.411-0.753, P < 0.001). Anticoagulants were associated with a lower risk of embolism (OR = 0.616, 95% CI = 0.392-0.966, P = 0.04), and this finding persisted in patients with NRAF (OR = 0.581, 95% CI 0.359-0.941, P = 0.03). No significant difference in the rate of hemorrhage/major bleeding was noted (OR = 1.497, 95% CI 0.730-3.070, P = 0.27), and this finding persisted on subgroup analysis. Anticoagulants appear to be more effective than aspirin in preventing embolisms in patients with AF, as the risk of bleeding is not increased.
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Affiliation(s)
- Jing-Tao Zhang
- From the Cardiac Arrhythmia Center (J-TZ, K-PC, SZ), Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China
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de Campos NLKL. Comparison of the occurrence of thromboembolic and bleeding complications in patients with mechanical heart valve prosthesis with one and two leaflets in the mitral position. Braz J Cardiovasc Surg 2014; 29:59-68. [PMID: 24896164 PMCID: PMC4389486 DOI: 10.5935/1678-9741.20140012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 12/09/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Patients with mechanical heart valve prostheses must continuously be treated with oral anticoagulants to prevent thromboembolic events related to prosthetesis. These patients should be continually evaluated for the control of oral anticoagulation. OBJECTIVE To compare the occurrence of thromboembolic and hemorragic complications in patients with mechanical heart valve prosthesis with one (mono) and two (bi) leaflets in the mitral position in anticoagulant therapy. METHODS We studied the 10-year interval, 117 patients with prosthesis in the mitral position, 48 with prosthetic single leaflet and 69 with two leaflets. We evaluated the occurrence of thromboembolic and hemorrhagic major and minor degree under gravity. The results are presented in an actuarial study and the frequency of occurrence of linear events. RESULTS The actuarial survival curves showed that over time, patients with prosthetic heart valve with one leaflet were less free of thromboembolic complications than patients with two leaflet prosthetic valve, while the latter (two leaflet) were less free of hemorrhagic accidents. The linearized frequency of occurrence of thromboembolism were higher in patients with mono leaflet prosthesis. Bleeding rates were higher for patients with bi leaflet prosthetic valve. CONCLUSION Patients with mono leaflet prosthetic heart valve showed that they are more prone to the occurrence of serious thromboembolic events compared to those with bi leaflet prosthetic valve. Patients with bi leaflet prosthetic valve had more bleeding than patients with mono leaflet prosthetic valve, however this difference was restricted to the bleeding of minor nature.
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Affiliation(s)
- Nelson Leonardo Kerdahi Leite de Campos
- Correspondence address: Nelson Leonardo Kerdahi Leite de Campos,
Faculdade de Medicina de Botucatu - UNESP, Avenida Prof. Montenegro, s/n - Distrito
de Rubião Júnior, Botucatu, SP, Brazil - Zip code: 18618-970. E-mail:
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Patel KK, Caramelli B, Gomes A. A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press. Clinics (Sao Paulo) 2011; 66:2159-68. [PMID: 22189744 PMCID: PMC3226614 DOI: 10.1590/s1807-59322011001200024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/07/2011] [Indexed: 11/21/2022] Open
Abstract
Recent original scientific contributions published in selected Brazilian periodicals and classifiable under cardiovascular and pulmonary subject categories cover a wide range of sub specialties, both clinical and experimental. Because they appear in journals with only recently enhanced visibility, we have decided to highlight a number of specific items appeared in four Brazilian journals, because we understand that this is an important subsidy to keep our readership adequately informed. These papers cover extensive sub-areas in both fields.
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