Efficacy and safety of argatroban in treatment of acute ischemic stroke:A meta-analysis

BACKGROUND Argatroban is a novel direct thrombin inhibitor that has been used for treatment of acute ischemic stroke(AIS).To our knowledge,no systematic analysis has assessed the efficacy and safety of argatroban for treatment of AIS.AIM To evaluate the efficacy and safety of argatroban for treatment of AIS.METHODS Cochrane Library,Medline,PubMed,and Web of Science were searched to retrieve all studies associated with argatroban and AIS.Effective rate,adverse events rate,and 95%confidence intervals were calculated and pooled using metaanalysis methodology.RESULTS We only found four randomized controlled studies,comprising 354 cases with 213 in the argatroban group and 141 in the control group.Great heterogeneity was found in the four studies(c2=11.44,I2=74%,P=0.01).Subgroup analysis could not be performed because of the absence of detailed data.The two most recent studies showed acceptable heterogeneity(c2=1.56,I2=36%,P=0.21).Our analysis showed that argatroban was not more effective than the control therapy in the acute phase of ischemic stroke(Z=0.01,P=0.99).Argatroban did not increase the risk of bleeding compared with the control group(c2=0.37,I2=0%,P=0.54,Z=0.80,P=0.42).CONCLUSION Patients with AIS might not benefit from argatroban and combination therapy with argatroban does not increase bleeding tendency.

Predisposing factors, diagnosis, treatment and prognosis of cerebral venous thrombosis during pregnancy and postpartum： a case-control study

Keywords pregnancy; puerperium; cerebral venous thromboembolism; anticoagulant agents; thrombolysis Background Previous investigations have demonstrated a relatively low incidence of stroke among young women, though both pregnancy and delivery can substantially increase the risk. Cerebral venous thrombosis may manifest different characteristics during pregnancy and postpartum as a result of their specific physiological statuses. This study aimed to identify the clinical manifestations, diagnosis, treatment, and prognosis of cerebral venous thrombosis during pregnancy and postpartum. Methods We conducted a retrospective analysis of 22 patients with cerebral venous thrombosis who were assigned to either group A （during pregnancy） or group B （during postpartum）. The relevant risk factors, initiation and development of the disease, clinical presentations, diagnosis, treatment, and prognosis were compared between the two stages. Results Cerebral venous thrombosis occurred during both pregnancy and postpartum, but was more common postpartum. Patients in group A had a longer hospitalization period than those in group B. Confirmed predisposing factors in 85.7% of patients of group A were dehydration, infection, and underlying cerebrovascular disorders. No obvious predisposing factors were identified in group B. The most frequent symptom was headache, with epileptic seizures, hemiparalysis and aphasia being less frequent symptoms. Focal neurological symptoms （P=0.022） and cerebral infarction （P=0.014） occurred more frequently in group A than in group B. Anticoagulation therapy proved to be safe for cerebral venous thrombosis patients during puerperium, regardless of parenchymal hemorrhage. However, more attention should be paid to spontaneous in-site placental hemorrhage in pregnant patients. Both groups had similar prognoses （P=1.000）, with 36.3% patients suffering from consequential dysfunction or recurrent intracranial hypertension Delayed diagnosis was associated with a poorer prognosis. Conclusions Cerebral venous thrombosis manifests different clinical characteristics during pregnancy and postpartum, though both have a good prognosis. Early diagnosis and prompt anticoagulation therapy are essential.

Calcium-containing versus calcium-free replacement solution in regional citrate anticoagulation for continuous renal replacement therapy:a randomized controlled trial

Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 hvs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing groupvs. 55.3 h (95% CI 49.7-60.9 h, log rankP = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/hvs. 169.0 ± 15.1 mL/h,P = 0.49). The mortality (14/35 [40%]vs. 13/29 [45%],P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73%vs. 14/24, 58%,P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of citrate accumulation in this study.Conclusions: When compared with calcium-free replacement solution, RCA-based CVVHDF with calcium-containing replacement solution had a similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and a large dose of intravenous calcium solution preparation for continuous calcium supplementation, it is more convenient to be applied in RCA-CRRT practice.

Factors Predicting Late Rectal Disorders after Radiation Therapy for Prostate Cancer

Background： Although various studies have been conducted on the effects of radiation therapy for prostate cancer, rectal toxicity after radiation therapy for prostate cancer, which is an important late adverse event associated with radiation therapy, has not been sufficiently examined. This study aimed to assess the associations of late rectal disorder （LRD） with dosimetric, anatomic, and clinical factors in patients with prostate cancer who underwent three-dimensional conformal radiation therapy （3D-CRT）. Methods： We retrospectively analyzed 104 patients undergoing 3D-CRT between January 2009 and October 2011. Thirty patients were administered anticoagulation/antiplatelet （AC/AP） agents. The standard dose was 74 Gy. Uni- and multi-va,iate analyses we,e performed to identify factors predictive of LRD after 3D-CRT. Results： The median follow-up period was 66 （range： 14 87） months. LRD occurred in 10.6% （11/104） of patients. The median time fi＇om RT to LRD was 15 months （range： 7MI months）. Sixty-four percent of those with LRD （7/11 patients） had been given AC/AP agents. Fitly-five （6/11 ） patients had severe internal iliac artery calcification. By univariate analysis, significant predictors of LRD were internal iliac artery calcification, administration of AC/AP agents, and age. Being very elderly was the significant predictor identified by multivariate analysis （P = 0.0276）. For patients receiving AC/AP agents and those with severe internal iliac artery calcification, the LRD incidences were 23.3% （7/30 patients） and 23.1% （6/26 patients）, respectively, and being 75 years of age or older was a significant predictor in these subsets. Conclusions： Our results suggest advanced age, administration of AC/AP agents, and severe internal iliac artery calcification to be risk factors tbr LRD in patients undergoing standard RT. Therefore, it is necessary to administer radiation with particular caution in the very elderly, especially those receiving AC/AP agents and/or with severe internal iliac artery calcification.