1. Home
  2. cohort studies

cohort studies

Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review

Author/s: 
Baumgartner, C., de Kouchkovsky, I., Whitaker, E., Fang, M.C.

Abstract

BACKGROUND:

Vitamin K antagonists (VKA) are the most widely used anticoagulants, and bridging is commonly administered during periprocedural VKA interruption. Given the unclear benefits and risks of periprocedural bridging in patients with previous venousthromboembolism, we aimed to assess recurrent venous thromboembolism and bleeding outcomes with and without bridging in this population.

METHODS:

We performed a systematic review searching the PubMed and Embase databases from inception to December 7, 2017 for randomized and nonrandomized studies that included adults with previous venous thromboembolism requiring VKA interruption to undergo an elective procedure, and that reported venous thromboembolism or bleeding outcomes. Quality of evidence was graded by consensus.

RESULTS:

We included 28 cohort studies (20 being single-arm cohorts) with, overall, 6915 procedures for analysis. In 27 studies reporting perioperative venous thromboembolism outcomes, the pooled incidence of recurrent venous thromboembolism with bridging was 0.7% (95% confidence interval [CI], 0.4%-1.2%) and 0.5% (95% CI, 0.3%-0.8%) without bridging. Eighteen studies reported major or nonmajor bleeding outcomes. The pooled incidence of any bleeding was 3.9% (95% CI, 2.0%-7.4%) with bridging and 0.4% (95% CI, 0.1%-1.7%) without bridging. In bridged patients at high thromboembolic risk, the pooled incidence for venous thromboembolism was 0.8% (95% CI, 0.3%-2.5%) and 7.5% (95% CI, 3.1%-17.4%) for any bleeding. Quality of available evidence was very low, primarily due to a high risk of bias of included studies.

CONCLUSIONS:

Periprocedural bridging increases the risk of bleeding compared with VKA interruption without bridging, without a significant difference in periprocedural venous thromboembolism rates.

Copyright © 2019 Elsevier Inc. All rights reserved.

KEYWORDS:

Anticoagulants; Bleeding; Bridging; PROSPERO; Periprocedural; Venous thromboembolism; registration number CRD42017074710

Keywords 
warfarin risk assessment hemorrhage anticoagulants bleeding Bridging Periprocedural

Influence of changes in diet quality on unhealthy aging: the Seniors-ENRICA cohort

Author/s: 
Ortolá, Rosario, García-Esquinas, Esther, García-Varela, Giselle, Struijkab, Ellen A., Rodríguez-Artalejo, Fernando, Lopez-Garcia, Esther

Background

Whether adopting a better diet in late life influences the aging process is still uncertain. Thus, we examined the association between changes in diet quality and unhealthy aging.

Methods

Data came from 2042 individuals aged ≥ 60 years recruited in the Seniors-ENRICA cohort in 2008–2010 (wave 0) and followed-up in 2012 (wave 1) and 2015 (wave 2). Diet quality was assessed with the Mediterranean Diet Adherence Screener (MEDAS), the Mediterranean Diet Score (MDS) and the Alternate Healthy Eating Index-2010 (AHEI-2010) at waves 0 and 1. Unhealthy ageing was measured using a 52-item health deficit accumulation index with 4 domains (functional, self-rated health/vitality, mental health, and morbidity/health services use) at each wave. An increase in dietary indices represents a diet improvement, and a lower deficit accumulation index indicates a health improvement.

Results

Compared with participants with a > 1-point decrease in MEDAS or MDS, those with a > 1-point increase showed lower deficit accumulation from wave 0 to wave 2 (multivariate β [95% CI]: –1.49 [− 2.88 to − 0.10], p-trend = 0.04 for MEDAS; and − 2.20 [− 3.56 to − 0.84], p-trend = 0.002 for MDS) and from wave 1 to wave 2 (− 1.34 [− 2.60 to − 0.09], p-trend = 0.04 for MEDAS). Also, participants with a > 5-point increase in AHEI-2010 showed lower deficit accumulation from wave 0 to wave 1 (− 1.15 [− 2.01 to − 0.28], p-trend = 0.009) and from wave 0 to wave 2 (− 1.21 [− 2.31 to − 0.10], p-trend = 0.03) than those with a > 5-point decrease. These results were mostly due to a strong association between improved diet quality and less functional deterioration.

Conclusions

In older adults, adopting a better diet was associated with less deficit accumulation, particularly functional deterioration. Improving dietary habits may delay unhealthy ageing. Our results have clinical relevance since we have observed that the deficit accumulation index decreases an average of 0.74 annually.

Keywords 
cohort study dietary patterns aging

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.

Author/s: 
US Preventive Services Task Force

IMPORTANCE:

The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015.

OBJECTIVE:

To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

FINDINGS:

Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer. (D recommendation).

Keywords 
cervical cancer screening
Subscribe to cohort studies