Heparin for the prevention of intraventricular hemorrhage in very preterm infants

Bruschettini, Matteo; Romantsik, Olga; Zappettini, Simona; Banzi, Rita; Ramenghi, Luca A.; Calevo, Maria Grazia

doi:10.1002/14651858.cd011718

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…After removing duplicates, 2153 publications were found in the search. Reference lists of included studies, as well as systematic reviews which referenced studies included in this review, (23,25,(35)(36)(37)(38)(39) were also screened. Ninety-six full texts were evaluated in total, with 56 randomised controlled trials included in this review (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review and network meta-analysis

Yao

Smit

Odd

2023

NPM

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BACKGROUND: Intraventricular haemorrhage (IVH) is a common problem in preterm infants, being a major cause of morbidity and mortality. Despite many randomised controlled trials comparing interventions to prevent IVH, the best prevention remains unclear. This study aims to review all the interventions which intended to reduce the incidence of IVH and compare them in a network meta-analysis. METHODS: A search on MEDLINE, EMBASE, Emcare, and CENTRAL was performed. Randomised controlled trials which evaluated neonatal interventions with a primary aim to reduce incidence of IVH in preterm infants were eligible. A surface under a cumulative ranking curve (SUCRA) was produced to indicate the intervention’s likelihood of being the most effective for preventing IVH. RESULTS: 40 studies were eligible, enrolling over 6760 infants. Twelve intervention groups were found, including delayed cord clamping, erythropoietin, ethamsylate, fresh frozen plasma, heparin, ibuprofen, indomethacin, magnesium, nursing interventions, sedation, tranexamic acid, and vitamin E. Vitamin E and indomethacin had the highest probability of being the best interventions to prevent IVH in premature infants, but interpretation of these results is difficult due to study limitations. CONCLUSION: Despite the impact of IVH, we were unable to identify a clearly beneficial treatment to reduce its incidence. Interpretation of the network meta-analysis was limited due to differences within studied populations, wide range of therapies trialled, and underlying advances in neonatal care between units, and over time. Although vitamin E and indomethacin appear to be promising candidates, contemporaneous trials of these, or novel agents, enrolling the most at-risk infants is needed urgently.

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Section: Resultsmentioning

confidence: 99%

The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review and network meta-analysis

Yao

Smit

Odd

2023

NPM

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“…Em uma revisão sistemática realizada que comparou a eficácia da heparina com outros anticoagulantes, não demonstrou diferença entre o uso de heparina de forma profilática, de outros anticoagulantes ou uso de placebo, não interferindo na ocorrência de hemorragia intraventricular ou na mortalidade associada a desfechos secundários (Bruschettini et al, 2016b).…”

Section: Tempo De Tratamento E Melhor Escolha De Anticoagulanteunclassified

Terapia De Anticoagulação Em Recém-Nascidos: Uma Revisão Integrativa

Silva,

Moita,

Hasegawa

et al. 2023

RECIMA21

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Os recém-nascidos (RN) tem o sistema de coagulação imaturo, só se regulariza no primeiro ano de vida, podendo ocorrer de forma tardia em cardiopatas. A necessidade do uso de terapia anticoagulante em RN vem aumentando nos últimos anos, mas ainda existem poucos estudos voltados para a população pediátrica, o que dificulta a padronização da droga de escolha e o ajuste da posologia. Trata-se de uma revisão de literatura integrativa sobre a terapia de anticoagulação em recém-nascidos. A trombose é um efeito de rara ocorrência em pacientes jovens, o grupo mais associado com esse evento (dentre os jovens) são os recém-nascidos. Dentre as drogas com ação anticoagulante, a mais utilizada nessa faixa etária é a heparina, por ser o fármaco que possui mais estudos comprovando a melhor ação e segurança dessas drogas. No entanto, ainda existe uma dificuldade no uso dessa droga, porque elas atuam se ligando as proteínas plasmáticas, e estas são reduzidas nos recém-nascidos. A heparina está fortemente associada a efeitos adversos na população pediátrica, por isso diversos estudos vêm sendo conduzidos para avaliar a eficácia do uso de anticoagulantes orais, como a varfarina e a dabigatrana. Existem poucos estudos que abordem a anticoagulação na pediatria, e os estudos que existem sobre o tema abordam apenas a heparina. Existem estudos em andamento que utilizam os fármacos orais e que trazem expectativas da liberação do uso dessas drogas para a faixa etária pediátrica nos próximos anos.

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Antithrombin for the prevention of intraventricular hemorrhage in very preterm infants

Bruschettini

Romantsik

Zappettini

et al. 2016

Cochrane Database of Systematic Reviews

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The administration of antithrombin seems not to reduce the incidence and severity of intraventricular hemorrhage in very preterm infants. Limited evidence is available on other clinically relevant outcomes. Given the imprecision of the estimate, the results of this systematic review are consistent with either a benefit or a detrimental effect of antithrombin and do not provide a definitive answer to the review question.

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Heparin for the prevention of intraventricular hemorrhage in very preterm infants

Cited by 3 publications

References 40 publications

The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review and network meta-analysis

The effectiveness of interventions to prevent intraventricular haemorrhage in premature infants: A systematic review and network meta-analysis

Terapia De Anticoagulação Em Recém-Nascidos: Uma Revisão Integrativa

Antithrombin for the prevention of intraventricular hemorrhage in very preterm infants

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