PDF(Pubmed)
Abstract：
BACKGROUND: Left ventricular assist devices (LVADs) have emerged as a successful treatment option for patients with end-stage heart failure. Compared with the best medical therapy, LVADs improve survival and enhance functional capacity and quality of life. However, two major complications compromise this patient population\'s outcomes: thrombosis and bleeding. Despite technological innovations and better hemocompatibility, these devices alter the rheology, triggering the coagulation cascade and, therefore, require antithrombotic therapy. Anticoagulation and antiplatelet therapies represent the current standard of care. Still, inconsistency in the literature exists, especially whether antiplatelet therapy is required, whether direct oral anticoagulants can replace vitamin K antagonists and even whether phosphodiesterase type 5 inhibitors with their antithrombotic effects could be added to the regimen of anticoagulation.
METHODS: We will perform a living systematic review with network meta-analysis and indirect comparison between current antithrombotic therapies, which have and have not been directly compared within clinical trials and observational studies. We will systematically search the following electronic sources: Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE). We will exclusively examine studies published in English from 2016 to the present. Studies conducted before 2016 will be omitted since our primary focus is evaluating continuous flow devices. Two independent reviewers will assess the articles by title, abstract and full text; any disagreement will be resolved through discussion, and a third reviewer will be involved if necessary. The Cochrane Risk of Bias tool will be used to assess the risk of bias. We will then conduct a pairwise meta-analysis; if the assumption of transitivity is satisfied, we will proceed with network meta-analysis using Bayesian methodology.
BACKGROUND: Formal ethical approval is not required as no primary data are collected. This systematic review and network meta-analysis will delineate the risks of stroke, thromboembolic events, pump thrombosis, gastrointestinal bleeding and mortality in patients equipped with LVADs who are subjected to various antithrombotic regimens. The findings will be disseminated via a peer-reviewed publication and presented at conference meetings. This will enhance clinical practice and guide future research on anticoagulation strategies within this distinct patient cohort.
UNASSIGNED: CRD42023465288.
METHODS: We will perform a living systematic review with network meta-analysis and indirect comparison between current antithrombotic therapies, which have and have not been directly compared within clinical trials and observational studies. We will systematically search the following electronic sources: Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Excerpta Medica Database (EMBASE). We will exclusively examine studies published in English from 2016 to the present. Studies conducted before 2016 will be omitted since our primary focus is evaluating continuous flow devices. Two independent reviewers will assess the articles by title, abstract and full text; any disagreement will be resolved through discussion, and a third reviewer will be involved if necessary. The Cochrane Risk of Bias tool will be used to assess the risk of bias. We will then conduct a pairwise meta-analysis; if the assumption of transitivity is satisfied, we will proceed with network meta-analysis using Bayesian methodology.
BACKGROUND: Formal ethical approval is not required as no primary data are collected. This systematic review and network meta-analysis will delineate the risks of stroke, thromboembolic events, pump thrombosis, gastrointestinal bleeding and mortality in patients equipped with LVADs who are subjected to various antithrombotic regimens. The findings will be disseminated via a peer-reviewed publication and presented at conference meetings. This will enhance clinical practice and guide future research on anticoagulation strategies within this distinct patient cohort.
UNASSIGNED: CRD42023465288.
摘要：
背景：左心室辅助装置（LVAD）已成为终末期心力衰竭患者的成功治疗选择。与最好的药物治疗相比，LVAD可提高生存率，提高功能能力和生活质量。然而,两个主要的并发症损害了该患者人群的预后：血栓形成和出血。尽管技术创新和更好的血液相容性，这些装置改变了流变学，触发凝血级联，因此,需要抗血栓治疗.抗凝和抗血小板治疗代表了当前的护理标准。尽管如此，文献中存在不一致，特别是是否需要抗血小板治疗，直接口服抗凝剂是否可以替代维生素K拮抗剂,甚至具有抗血栓作用的5型磷酸二酯酶抑制剂是否可以添加到抗凝方案中.
方法：我们将通过网络荟萃分析和间接比较当前抗血栓治疗，在临床试验和观察性研究中已经和尚未直接比较。我们将系统地搜索以下电子来源：Cochrane中央控制试验登记册（CENTRAL），医学文献在线分析和检索系统（MEDLINE）和摘录医学数据库（EMBASE）。我们将专门研究从2016年到现在以英语发表的研究。由于我们的主要重点是评估连续流设备，因此将省略2016年之前进行的研究。两名独立审稿人将按标题评估文章，摘要和全文；任何分歧将通过讨论解决，如有必要，将有第三位审稿人参与。Cochrane偏差风险工具将用于评估偏差风险。然后，我们将进行成对荟萃分析；如果传递性的假设得到满足，我们将使用贝叶斯方法进行网络荟萃分析。
背景：不需要正式的伦理批准，因为没有收集主要数据。本系统综述和网络荟萃分析将描述中风的风险，血栓栓塞事件,泵血栓形成,接受各种抗血栓治疗的LVAD患者的胃肠道出血和死亡率。调查结果将通过同行评审的出版物传播，并在会议上介绍。这将加强临床实践，并指导未来在这一不同患者队列中的抗凝策略研究。
■CRD42023465288。
方法：我们将通过网络荟萃分析和间接比较当前抗血栓治疗，在临床试验和观察性研究中已经和尚未直接比较。我们将系统地搜索以下电子来源：Cochrane中央控制试验登记册（CENTRAL），医学文献在线分析和检索系统（MEDLINE）和摘录医学数据库（EMBASE）。我们将专门研究从2016年到现在以英语发表的研究。由于我们的主要重点是评估连续流设备，因此将省略2016年之前进行的研究。两名独立审稿人将按标题评估文章，摘要和全文；任何分歧将通过讨论解决，如有必要，将有第三位审稿人参与。Cochrane偏差风险工具将用于评估偏差风险。然后，我们将进行成对荟萃分析；如果传递性的假设得到满足，我们将使用贝叶斯方法进行网络荟萃分析。
背景：不需要正式的伦理批准，因为没有收集主要数据。本系统综述和网络荟萃分析将描述中风的风险，血栓栓塞事件,泵血栓形成,接受各种抗血栓治疗的LVAD患者的胃肠道出血和死亡率。调查结果将通过同行评审的出版物传播，并在会议上介绍。这将加强临床实践，并指导未来在这一不同患者队列中的抗凝策略研究。
■CRD42023465288。
