التفاصيل البيبلوغرافية
| العنوان: |
Anticoagulation in the management of neonatal cerebral sinovenous thrombosis: a systematic review and meta-analysis. |
| المؤلفون: |
Rossor, Thomas, Raman Singh, Rahul, Arichi, Tomoki, Bhate, Sanjay, Hart, Anthony R. |
| المصدر: |
Developmental Medicine & Child Neurology; Sep2018, Vol. 60 Issue 9, p884-891, 8p |
| مصطلحات موضوعية: |
ANTICOAGULANTS, NEONATAL diseases, CEREBRAL embolism & thrombosis, INTRACEREBRAL hematoma, META-analysis, CEREBRAL hemorrhage treatment, BEM Sex-Role Inventory, CEREBRAL hemorrhage, SINUS thrombosis, SYSTEMATIC reviews, DISEASE complications, THERAPEUTICS |
| الملخص (بالإنجليزية): |
Aim: To determine whether anticoagulation therapy (ACT) in the treatment of neonatal cerebral sinovenous thrombosis (CSVT) improves outcomes, in the presence or absence of pre-existing intracerebral haemorrhage (ICH).Method: We searched CENTRAL, MEDLINE, Embase, CINAHL, the Web of Science, and clinical trial databases. We considered data from retrospective and prospective cohort studies, case series, and randomized controlled studies evaluating outcomes of CSVT treated with anticoagulation or no anticoagulation. Studies were included if they involved infants either younger than 28 days of age or younger than 44 weeks postmenstrual age at the time of diagnosis of CSVT in which ACT was considered.Results: Seven non-randomized studies were included in meta-analysis. ACT had no significant effect on mortality before discharge either in the presence or absence of pre-existing ICH, nor on the incidence of extension of pre-existing ICH. ACT was associated with a reduced risk of propagation of thrombus (risk ratio 0.14, 95% confidence interval 0.03-0.72).Interpretation: There are no randomized trials assessing the safety and efficacy of ACT in the treatment of neonatal CSVT. The results of this meta-analysis would justify a position of equipoise and support the need for well-designed randomized controlled trials of ACT in this population.What This Paper Adds: No randomized studies have evaluated anticoagulation therapy (ACT) in neonatal cerebral sinovenous thrombosis. ACT may reduce thrombus propagation. No evidence of increased morbidity or mortality with ACT was demonstrated. A position of equipoise is justified, supporting the need for placebo-controlled randomized trials. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): |
Resumen: Anticoagulación en el tratamiento de la trombosis sinovenosa cerebral neonatal: una revisión sistemática y metaanálisis: Objetivo: Determinar si la terapia anticoagulante (ACT) en el tratamiento de la trombosis sinovenosa cerebral neonatal (CSVT) mejora los resultados, en presencia o ausencia de hemorragia intracerebral preexistente (HIC). Método: Se realizaron búsquedas en CENTRAL, MEDLINE, Embase, CINAHL, la Web of Science y las bases de datos de ensayos clínicos. Se consideraron los datos de estudios de cohortes retrospectivos y prospectivos, series de casos y estudios controlados aleatorios que evaluaron los resultados de CSVT tratados con anticoagulación o sin anticoagulación. Los estudios se incluyeron si incluían niños menores de 28 días o menores de 44 semanas de edad postmenstrual en el momento del diagnóstico de CSVT y que se consideró ACT. Resultados: Siete estudios no aleatorizados se incluyeron en el metaanálisis. La ACT no tuvo un efecto significativo sobre la mortalidad antes del alta, ya sea en presencia o ausencia de HIC preexistente, ni en la incidencia de la extensión de HIC preexistente. La TCA se asoció con un riesgo reducido de propagación del trombo (cociente de riesgos 0.14; intervalo de confianza del 95%: 0.03–0.72). Interpretación: No hay ensayos aleatorizados que evalúen la seguridad y eficacia de la ACT en el tratamiento de CSVT neonatal. Los resultados de este metaanálisis justificarían una posición de equilibrio (equipoise) y apoyarían la necesidad de ensayos controlados aleatorios bien diseñados de ACT en esta población. [ABSTRACT FROM AUTHOR] |
| Abstract (Portuguese): |
Resumo: Anti‐coagulação no manejo da trombose sinovenosa cerebral neonatal: uma revisão sistemática e metanálise: Objetivo: Determinar se a terapia anticoagulação (TAC) no tratamento da trombose sinovenosa cerebral (TSVC) neonatal melhora os resultados, na presença ou ausência de hemorragia intracerebral (HIC) pré‐existente. Método: Buscamos bases de dados CENTRAL, MEDLINE, Embase, CINAHL, the Web of Science, e de estudos clínicos. Consideramos dados de estudos de coorte prospectivos e retrospectivos, séries de casos, e estudos randomizados controlados avaliando os resultados da TSVC tratada com anticoagulação ou sem anticoagulação. Os estudos foram incluídos se envolvessem lactentes ou crianças com menos de 28 dias de idade ou com menos de 44 semanas de idade pós‐menstrual no momento do diagnóstico de TSVC em que a TAC foi considerada. Resultados: Sete estudos não randomizados foram incluídos na metanálise. A TAC não teve efeito significativo na mortalidade antes da alta, tanto na presença quanto na ausência de HIC, nem na inciência de extensão de HIC pré‐existente. A TAC se associou com risco reduzido de propagação do trombo (razão de risco 0.14, intervalo de confiança 95% 0.03–0.72). Interpretação: Não há estudos randomizados avaliando a segurança e eficácia da TAC no tratamento da TSVC. Os resultados desta metanálise justificarima uma posição de cautela e suportam a necessidade de estudos randomizados controlados bem desenhados sobre a TAC nesta população. [ABSTRACT FROM AUTHOR] |
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