Efficacy and Safety of Rivaroxaban Compared with Other Therapies Used in Patients with Peripheral Artery Disease Undergoing Peripheral Revascularization: A Systematic Literature Review and Network Meta-Analysis.

BACKGROUND: The guidelines on antithrombotic treatment in patients with symptomatic peripheral artery disease (PAD) undergoing peripheral revascularization of the lower extremities were developed based on heterogeneous trials, assessing various dose regimens and recruiting patients who were subjected to different revascularization procedures. OBJECTIVE: To compare efficacy and safety of treatments used in patients with PAD undergoing peripheral revascularization accounting for between-trial heterogeneity and large dispersion of the quality of evidence. METHODS: A systematic literature review of randomised controlled trials (RCTs) recruiting adult patients with PAD receiving antithrombotics was conducted until January 2020. Hazard ratios (HR) were pooled using Bayesian network meta-analysis. The estimated between-treatment effects were presented as HR together with 95% credible intervals. The base case analysis included studies recruiting patients following recent peripheral revascularization, who received treatment regimens administered within the recommended therapeutic window, while a sensitivity scenario included all identified trials. RESULTS: Thirteen RCTs were identified (8 RCTs enrolled patients following peripheral revascularization and 5 RCTs regardless of the previous revascularization). Five trials, recruiting an overall of 8349 patients, were considered for the base case analysis. Of those, 6564 patients were recruited in the VOYAGER PAD trial comparing rivaroxaban plus aspirin (RIV plus ASA) versus ASA. RIV plus ASA was associated with a lower risk of repeated peripheral revascularization versus ASA monotherapy (HR = 0.88 [0.79, 0.99]), however having a trend towards an increased rate of major bleeding (HR = 1.43 [0.98, 2.11]). There was no evidence for differences between RIV plus ASA and dual antiplatelet therapy and vitamin K antagonists plus ASA. Similar results were observed in sensitivity analyses. CONCLUSIONS: RIV plus ASA is associated with reduced risk of revascularization compared with ASA monotherapy, but the evidence for other comparators, in particular antiplatelet regimens, was insufficient to guide treatment decisions and highlights the challenge in establishing the magnitude of comparative efficacy using existing RCTs.

Sulforaphane-conjugated selenium nanoparticles: towards a synergistic anticancer effect.

Sulforaphane-modified selenium nanoparticles can be prepared in a simple aqueous-phase redox reaction through reduction of selenite with ascorbic acid. The sulforaphane molecules present in the reaction mixture adsorb on the nanoparticle surface, forming an adlayer. The resulting conjugate was examined with several physicochemical techniques, including microscopy, spectroscopy, x-ray diffraction, dynamic light scattering and zeta potential measurements. As shown in in vivo investigations on rats, the nanomaterial administered intraperitoneally is eliminated mainly in urine (and, to a lesser extent, in feces); however, it is also retained in the body. The modified nanoparticles mainly accumulate in the liver, but the basic parameters of blood and urine remain within normal limits. The sulforaphane-conjugated nanoparticles reveal considerable anticancer action, as demonstrated on several cancer cell cultures in vitro. This finding is due to the synergistic effect of elemental selenium and sulforaphane molecules assembled in one nanostructure (conjugate). On the other hand, the cytotoxic action on normal cells is relatively low. The high antitumor activity and selectivity of the conjugate with respect to diseased and healthy cells is extremely promising from the point of view of cancer treatment.

Medical and Economic Advantages of Postoperative Blood Salvage in Total Knee Replacement.

BACKGROUND: Total knee replacement surgery causes large blood loss leading to worsening of the patient's physical capacity, difficulties in rehabilitation and necessity of transfusions. The re-infusion of drainage fluid has been described as an alternative way to improve hematological parameters. The aim of the study was to determine the effectiveness of re-transfusion with regard to the allogeneic transfusion rate, duration of treatment and costs. MATERIAL AND METHODS: We performed a prospective randomized study of 101 patients, divided into an RTF group for re-transfusion from the drain and a DRN group for standard drainage. We could not re-transfuse drainage blood in 6 cases. 38 patients (RTF2) received their blood back and the remaining 63 patients (DRN2) did not. Depending on blood loss, laboratory tests and general condition, decisions were made to proceed with allogeneic transfusions. RESULTS: In spite of the re-transfusion, 39.4% of the patients in RTF2 required an additional transfusion, compared to 53.9% of the patients in DRN2 (p=0.15). Mean deterioration in hematological parameters was 72.9% of baseline in RTF2 and 75.0% in DRN2 (p=0.45), mean treatment time was 10.3 days for RTF2 and 11.1 for DRN2 (p=0,24) and mean cost was PLN 5426.5 in RTF versus PLN 5587.21 in DRN (p=0.76). CONCLUSION: The effect of re-transfusion on reducing allogeneic blood usage is not significant, does not alter patients' general condition and lab test results and does not eliminate the need for transfusion or influence the duration of hospital stay and the costs.

Retransfusion of shed blood collected in drains after Total Knee Replacement.

BACKGROUND: Total knee arthroplasty is associated with a perioperative blood loss, which is usually addressed with transfusion of allogenic blood. The possible risks of such treatment include viral infection, immunologic complications and occasional lack of blood products. Recently, retransfusion of blood recovered from the operative field or drains has become an effective treatment for blood loss. The purpose of this study was to evaluate the clinical usefulness of autologous transfusion of blood recovered from drains and to determine if the retransfusion alone is sufficient for treatment of the perioperative blood loss. MATERIALS AND METHODS: A retrospective evaluation of 214 patients (240 knees) was performed. Standard suction drains were used in 127 cases, whereas in 113 cases we used the HandyVac retransfusion system. The comparative analysis included the preoperative haemoglobin level, surgery time, length of hospitalisation, incidence of fever and demand for allogenic blood transfusion. RESULTS: Retransfusion of blood from drains decreased the incidence of allogenic transfusion from 69.3% to 43.4%. The global demand for blood products was reduced by 42%. The use of retransfusion kits did not increase surgery time. In the retransfusion group, the incidence of elevated body temperature and number of days with fever per one patient were higher than in the allogenic transfusion group. CONCLUSIONS: Retransfusion of shed blood from drains decreases the demand for allogenic blood. However, it does not eliminate the need for transfusion. The method is simple and relatively safe. It does not increase surgery time. No serious adverse effects were noted apart from elevated body temperature. A low preoperative haemoglobin level was a risk factor for additional allogenic transfusions in patients who have received retransfusion.