All-cause mortality after major gastrointestinal bleeding among patients receiving direct oral anticoagulants: a protocol for a systematic review and meta-analysis

Chornenki, Nicholas L. Jackson; Tritschler, Tobias; Stucki, Fabian; Odabashian, Roupen; Leentjens, Jenneke; Khan, Faizan; Ly, Valentina; Siegal, Deborah

doi:10.1186/s13643-022-02146-5

Cited by 2 publications

(2 citation statements)

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“…If disagreements exist, they will be resolved through discussion or consultation with a third reviewer (WZ). In addition, as a part of reporting bias assessment, we will use Begg’s rank correlation and Egger’s weighted regression tests to assess the publication bias,34 and a funnel plot will be used when a meta-analysis includes 10 or more studies 35. If publication bias exists, the trim and fill method will be used to evaluate its effect on the results 36…”

Section: Methods and Analysismentioning

confidence: 99%

“…In addition, as a part of reporting bias assessment, we will use Begg's rank correlation and Egger's weighted regression tests to assess the publication bias, 34 and a funnel plot will be used when a meta-analysis includes 10 or more studies. 35 If publication bias exists, the trim and fill method will be used to evaluate its effect on the results. 36 Assessment of the quality and certainty of the evidence We will use the GRADE system to evaluate the certainty of evidence.…”

Section: Assessment Of Reporting Biasmentioning

confidence: 99%

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Low-dose intravenous immunoglobulin for children with newly diagnosed immune thrombocytopenia: protocol of a systematic review and meta-analysis

Ren

Zhang

et al. 2023

BMJ Open

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IntroductionIntravenous immunoglobulin (IVIg) is a first-line treatment for children with newly diagnosed immune thrombocytopenia (ITP). However, the cost of IVIg is high. Higher doses of IVIg are associated with a more insupportable financial burden to paediatric patients’ families and may produce more adverse reactions. Whether low-dose IVIg can quickly stop bleeding and induce a durable response in treating children with newly diagnosed ITP is not yet established.Methods and analysisWe will extensively search five English databases (PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature) and three Chinese databases (CNKI, Wanfang and VIP). International Clinical Trials Registry Platform and ClinicalTrials.gov will also be searched as supplementary. Randomised controlled trials and prospective observational studies compared the efficacy of low-dose IVIg and high-dose or moderate-dose IVIg will be included. The primary outcome is the proportion of patients achieving durable response. Estimates of effect will be pooled with either a random-effect model or a fixed-effect model according to the heterogeneity of studies. If significant heterogeneity exists, we will conduct subgroup analysis and sensitivity analysis to explore the source of heterogeneity and evaluate the robustness of the results. Publication bias will also be assessed, if possible. The risk of bias will be assessed using the Risk of Bias 2 and Risk Of Bias In Non-randomised Studies of Interventions tools. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.Ethics and disseminationNo ethical approval is required since this systematic review is based on previously published studies. The findings of this study will be presented at international conferences or published in a peer-reviewed journal.PROSPERO registration numberCRD42022384604.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Assessment Of Reporting Biasmentioning

confidence: 99%

Low-dose intravenous immunoglobulin for children with newly diagnosed immune thrombocytopenia: protocol of a systematic review and meta-analysis

Ren

Zhang

et al. 2023

BMJ Open

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Comparative Outcomes of Warfarin vs. Direct Oral Anticoagulants (DOACs) in Anticoagulant-Related Gastrointestinal Bleeding: A Single-Center Study

Ullah,

Arif,

Khan

et al. 2024

Cureus

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Background: The management of thromboembolic risk and the necessity for timely hemorrhage control make anticoagulant-related gastrointestinal (GI) bleeding clinically challenging. Objective: This study aimed to evaluate clinical outcomes (such as bleeding control and mortality) and the effectiveness of anticoagulation reversal techniques in patients with anticoagulant-related GI bleeding in emergency settings. Methodology: This prospective, observational study conducted at Lady Reading Hospital, Peshawar, from January to December 2023, included patients aged 18 or older with GI bleeding on warfarin or direct oral anticoagulants (DOACs). Key clinical data, including demographics and comorbidities, were collected. The study followed a multidisciplinary approach with emergency physicians, gastroenterologists, and surgeons. Pharmacologic management (Vitamin K for warfarin and idarucizumab for DOACs) was initiated based on clinical judgment, with endoscopic interventions performed within 24 hours if needed, and surgical intervention considered if other methods failed or complications arose. Outcomes such as bleeding control, transfusion needs, and mortality were tracked. Data were collected prospectively via case report forms, and patients were followed for up to six months post-discharge. Statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY), with descriptive statistics for all variables. Continuous variables were compared using independent t-tests, and categorical data were assessed using chi-square tests. Adjusted odds ratios were calculated for mortality and bleeding control outcomes, accounting for confounders. Results: A total of 384 patients were included, with 180 (46.88%) on warfarin and 204 (53.12%) on DOACs. Bleeding control was significantly better in the DOAC group (170/204, 83.33% vs. 130/180, 72.22%, P = 0.03), while mortality was higher in patients on warfarin (20, 11.11% vs. 10, 4.90%, P = 0.02). Patients on warfarin also had longer hospital stays (6.89 vs. 5.52 days, P = 0.01) and times to intervention (5.28 vs. 4.64 hours, P = 0.03). Although demographic characteristics (e.g., age and gender) and comorbidities (e.g., hypertension and diabetes) were comparable between groups, DOACs showed safer profiles during hospitalization. Long-term follow-up outcomes, including readmission rates, recurrent bleeding, and post-discharge mortality, were similar across both groups. Conclusions: The study demonstrates that DOACs offer better outcomes in bleeding control and mortality compared to warfarin in anticoagulant-related GI bleeding, emphasizing the importance of tailored treatment strategies. These findings highlight the potential benefits of DOACs in emergency settings, supporting the need for customized management plans to optimize patient outcomes.

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All-cause mortality after major gastrointestinal bleeding among patients receiving direct oral anticoagulants: a protocol for a systematic review and meta-analysis

Cited by 2 publications

References 28 publications

Low-dose intravenous immunoglobulin for children with newly diagnosed immune thrombocytopenia: protocol of a systematic review and meta-analysis

Low-dose intravenous immunoglobulin for children with newly diagnosed immune thrombocytopenia: protocol of a systematic review and meta-analysis

Comparative Outcomes of Warfarin vs. Direct Oral Anticoagulants (DOACs) in Anticoagulant-Related Gastrointestinal Bleeding: A Single-Center Study

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