Objective To evaluate differences in thrombo-inflammatory biomarkers between patients with severe COVID-19 infection/death and mild infection. Patients and Methods Medline, Cochrane Central Register of Controlled Trials, Embase, EBSCO, Web of Science, and CINAHL databases were searched for studies comparing thrombo-inflammatory biomarkers in COVID-19 among severe/non-survivors and non-severe/survivors from January 1, 2020 through July 11, 2020. Inclusion criteria: (1) hospitalized patients ≥18 years comparing severe/non-survivors vs. non-severe/survivors; (2) biomarkers of inflammation and/or thrombosis. A random-effects model was used to estimate the weighted mean difference (WMD) between the two groups of COVID-19 severity. Results Seventy-five studies were included (17,052 patients). Patients with severe COVID-19/non-survivors were older, a greater proportion were men, had a higher prevalence of hypertension, diabetes, cardiac or cerebrovascular disease, chronic kidney disease, malignancy, and COPD. The thrombo-inflammatory biomarkers were significantly higher in patients with severe disease including D-dimer (WMD 0.60, 0.49-0.71, I 2 =83.85%), fibrinogen (WMD 0.42, 0.18-0.67, I 2 =61.88%, p<0.001), CRP (WMD 35.74, 30.16-41.31, I 2 =85.27%), high sensitivity-CRP (WMD 62.68, 45.27-80.09, I 2 =0%), Interleukin-6 (WMD 22.81, 17.90-27.72, I 2 =90.42%) and, ferritin (WMD 506.15, 356.24-656.06, I 2 =52.02%). Moderate to significant heterogeneity was observed for all parameters. Sub-analysis based on disease severity, mortality, and geographic region of studies demonstrated similar inferences. Conclusions Thrombo-inflammatory biomarkers (D-dimer, Fibrinogen, CRP, hs-CRP, ferritin, and IL-6) and marker of end-organ damage (hs-Troponin I) are associated with increased severity and mortality in COVID-19 infection.

ImportanceDirect oral anticoagulant (DOAC)–associated intracranial hemorrhage (ICH) has high morbidity and mortality. The safety and outcome data of DOAC reversal agents in ICH are limited.ObjectiveTo evaluate the safety and outcomes of DOAC reversal agents among patients with ICH.Data SourcesPubMed, MEDLINE, The Cochrane Library, Embase, EBSCO, Web of Science, and CINAHL databases were searched from inception through April 29, 2022.Study SelectionThe eligibility criteria were (1) adult patients (age ≥18 years) with ICH receiving treatment with a DOAC, (2) reversal of DOAC, and (3) reported safety and anticoagulation reversal outcomes. All nonhuman studies and case reports, studies evaluating patients with ischemic stroke requiring anticoagulation reversal or different dosing regimens of DOAC reversal agents, and mixed study groups with DOAC and warfarin were excluded.Data Extraction and SynthesisPreferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used for abstracting data and assessing data quality and validity. Two reviewers independently selected the studies and abstracted data. Data were pooled using the random-effects model.Main Outcomes and MeasuresThe primary outcome was proportion with anticoagulation reversed. The primary safety end points were all-cause mortality and thromboembolic events after the reversal agent.ResultsA total of 36 studies met criteria for inclusion, with a total of 1832 patients (967 receiving 4-factor prothrombin complex concentrate [4F-PCC]; 525, andexanet alfa [AA]; 340, idarucizumab). The mean age was 76 (range, 68-83) years, and 57% were men. For 4F-PCC, anticoagulation reversal was 77% (95% CI, 72%-82%; I2 = 55%); all-cause mortality, 26% (95% CI, 20%-32%; I2 = 68%), and thromboembolic events, 8% (95% CI, 5%-12%; I2 = 41%). For AA, anticoagulation reversal was 75% (95% CI, 67%-81%; I2 = 48%); all-cause mortality, 24% (95% CI, 16%-34%; I2 = 73%), and thromboembolic events, 14% (95% CI, 10%-19%; I2 = 16%). Idarucizumab for reversal of dabigatran had an anticoagulation reversal rate of 82% (95% CI, 55%-95%; I2 = 41%), all-cause mortality, 11% (95% CI, 8%-15%, I2 = 0%), and thromboembolic events, 5% (95% CI, 3%-8%; I2 = 0%). A direct retrospective comparison of 4F-PCC and AA showed no differences in anticoagulation reversal, proportional mortality, or thromboembolic events.Conclusions and RelevanceIn the absence of randomized clinical comparison trials, the overall anticoagulation reversal, mortality, and thromboembolic event rates in this systematic review and meta-analysis appeared similar among available DOAC reversal agents for managing ICH. Cost, institutional formulary status, and availability may restrict reversal agent choice, particularly in small community hospitals.

No abstract

Background : Several randomized trials have evaluated the efficacy of prophylactic magnesium (Mg) supplementation in prevention of post-operative atrial fibrillation (POAF) in patients undergoing cardiac artery bypass grafting (CABG). We aimed to determine the role of prophylactic Mg in 3 different settings (intraoperative, postoperative, intraoperative plus postoperative) in prevention of POAF. Methods: A systemic literature search was performed (until January 19, 2019) using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify trials evaluating Mg supplementation post CABG. Primary outcome of our study was reduction in POAF post CABG. Results: We included a total of 2,430 participants (1,196 in the Mg group and 1,234 in the placebo group) enrolled in 20 randomized controlled trials. Pooled analysis demonstrated no reduction in POAF between the two groups (RR 0.90; 95% CI, 0.79-1.03; p=0.13; I 2 =42.9%). In subgroup analysis, significant reduction in POAF was observed with postoperative Mg supplementation (RR 0.76; 95% CI, 0.58-0.99; p=0.04; I 2 =17.6%) but not with intraoperative or intraoperative plus postoperative Mg supplementation (RR 0.77; 95% CI, 0.49-1.22; p = 0.27; I 2 =49% and RR 0.92; 95% CI, 0.68-1.24; p = 0.58; I 2 =51.8%, respectively). Conclusions: Magnesium supplementation, especially in the postoperative period, is an effective strategy in reducing POAF following CABG.

No abstract