Browsing by Author "Zamora, J."
Now showing 1 - 3 of 3
- Results Per Page
- Sort Options
Item Efficacy and safety outcomes of recanalization procedures in patients with acute symptomatic pulmonary embolism: systematic review and network meta-analysis.(Thorax, 2017) Jiménez, D.; Martín Saborido, Carlos; Muriel, A.; Zamora, J.; Morillo, R.; Barrios, D.; Klok, F. A.; Huisman, M. V.; Tapson, V.; Yusen, R. D.Background We aimed to review the efficacy and safety of recanalisation procedures for the treatment of PE. Methods We searched PubMed, the Cochrane Library, EMBASE, EBSCO, Web of Science and CINAHL databases from inception through 31 July 2015 and included randomised clinical trials that compared the effect of a recanalisation procedure versus each other or anticoagulant therapy in patients diagnosed with PE. We used network meta-analysis and multivariate randomeffects meta-regression to estimate pooled differences between each intervention and meta-regression to assess the association between trial characteristics and the reported effects of recanalisation procedures versus anticoagulation. Results For all-cause mortality, there were no significant differences in event rates between any of the recanalisation procedures and anticoagulant treatment (full-dose thrombolysis: OR 0.60; 95% CI0.36 to 1.01; low-dose thrombolysis: 0.47; 95%CI 0.14 to 1.59; and catheter-associated thrombolysis: 0.31; 95%CI 0.01 to 7.96). Full-dose thrombolysis increased the risk of major bleeding (2.00; 95%CI 1.06 to 3.78) compared with anticoagulation. Catheter-directed thrombolysis was associated with the lowest probability of dying (surface under the cumulative ranking curve (SUCRA), 0.67), followed by low-dose thrombolysis (SUCRA, 0.66) and full-dose thrombolysis (SUCRA, 0.55). Similarly, low-dose thrombolysis was associated with the lowest probability of major bleeding (SUCRA, 0.61), followed by catheterdirected thrombolysis (SUCRA, 0.54) and full-dose thrombolysis (SUCRA, 0.17). The results were similar in sensitivity analyses based on restricting only to studies in haemodynamically stable patients with PE. Conclusions In the treatment of PE, recanalisation procedures do not seem to offer a clear advantage compared with standard anticoagulation. Low-dose thrombolysis was associated with the lowest probability of dying and bleedingItem Risk of miscarriage after chorionic villus sampling.(Ultrasound in Obstetrics and Gynecology, 2020) Gil Mira, María del Mar; Molina, F. S.; Rodríguez Fernández, M.; Delgado, J. L.; Carrillo, M. P.; Jani, J.; Plasencia, W.; Stratieva, V.; Maíz, N.; Carretero, P.; Lismonde, A.; Chaveeva, P.; Burgos, J.; Santacruz Martín, Belén; Zamora, J.; De Paco Matallana, C.Objective To estimate the risk of miscarriage associated to chorionic villus sampling (CVS). Methods This was a retrospective cohort study performed in eight fetal‐medicine units in Spain, Belgium and Bulgaria. Two populations were included: first, all singleton pregnancies attending to their first‐trimester assessment in Murcia, Spain, and second, all singleton pregnancies having a CVS following first‐trimester assessment at any of the participating centers. We used propensity score matching analysis to estimate the association between CVS and miscarriage. We compared risks of miscarriage of CVS and non‐CVS groups after propensity score matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that lead to CVS, in a similar way in which randomization operates in a randomized clinical trial. Results The study population consisted of 22,250 participants in the non‐CVS group and 3,613 in the CVS group. The incidence of miscarriage in the CVS group was 2.1% (77/3,613), which was significantly higher than the 0.9% (207/22,250) in the non‐CVS group (p <0.001). The propensity score algorithm matched 2,122 CVS cases with 2,122 non‐CVS cases including 40 (1.9%) and 55 (2.6%) miscarriages in the CVS and non‐CVS groups, respectively (OR 0.72 [95% CI 0.48 to 1.10]; p = 0.146). However, we found a significant interaction between the CVS risk of miscarriage and the risk of aneuploidies, suggesting a different effect of the CVS for different baseline characteristics in such a way that, when the risk of aneuploidies is low, the risk after CVS increases (OR 2.87 [95% CI 1.13 to 7.30]) but when the risk is high, the risk after CVS is paradoxically reduced (OR 0.47 [95% CI 0.28 to 0.76]), presumably due to prenatal diagnosis and termination of major aneuploidies that would have otherwise resulted in spontaneous miscarriage. Conclusions The risk of miscarriage in women having a CVS is about 1% higher than in women without CVS, although this excess risk is not entirely due to the invasive procedure but to some extent the demographic and pregnancy characteristics of the patient undergoing CVS. After accounting for these risk factors and confining the analysis to low‐risk pregnancies, CVS seems to increase the risk of miscarriage about three times above the patient’s background‐risk. Although this is a substantial increase in relative terms, in pregnancies without risk factors, the risk of miscarriage after CVS will still remain low and similar to or slightly higher than that of the general population. For example, if her risk of aneuploidy is 1 in a 1,000 (0.1%), her risk of miscarriage after CVS will increase to 0.3% (0.2% higher).Item Sex as a prognostic factor for mortality in adults with acute symptomatic pulmonary embolism.(Cochrane Database of Systematic Reviews, 2021) López Alcalde, Jesús; Stallings, E.; Zamora, J.; Muriel, A.; Van Doorn, S.; Álvarez Díaz, N.; Fernández Félix, B.; Quezada Loaiza, C.; Pérez, R.; Jiménez, D.This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: To determine whether sex (i.e. being a male or a female) is an independent (i.e. autonomous) prognostic factor for predicting mortality in adults with acute symptomatic PE. See Table 1 for a formulation of the review question in population, index prognostic factor, comparator, outcome(s), timing, and setting (PICOTS) format.