The first step in the validation of a new screen for violence risk in acute psychiatry: The inpatient context

Background

Instruments for evaluating the risk of violence towards others have mostly been developed for assessment of risk for recidivism into violent crime in forensic psychiatry. In general psychiatry there is a considerable need for specialised, brief and structured assessment tools to inform risk decisions.

Method

The study aimed to validate a brief structured clinical risk assessment screen of inpatient violence (V-RISK-10), a 10-item structured clinical checklist with a good vignette-based interrater reliability (ICC=0.87). In this study it was used for risk assessment of a one-year sample of patients (N = 1.017) admitted to two acute psychiatric units. Risk assessments at admission were compared to prospective records of aggressive and violent acts during the hospital stay.

Results

Results showed a base rate for aggression of 9%. The predictive validity of the V-RISK-10 was estimated by Receiver Operating Characteristics (ROC). It yielded an area under the curve (AUC) of 0.83, with sensitivity/specificity of 0.81/0.73 and corresponding positive and negative predictive values (PPV/NPV) of 0.24/0.97. The screen was easy-to-use and showed a short completion time.

Conclusion

Despite promising results further validation studies are required before the V-RISK-10 is adopted into routine clinical practise.     

Early retirement from work among employees with a diagnosis of personality disorder compared to anxiety and depressive disorders

Objective

Risk of retirement from work before statutory retirement age among employees with personality disorders is unknown.

Method

We used diagnoses of awarded medical rehabilitations and hospitalisations to select two clinical cohorts from a population of 151,618 employees: participants in rehabilitation (total N = 1942, 233 personality disorder, 419 anxiety disorder and 1290 depression cases) and hospitalised patients (N = 1333, 354, 126 and 853, respectively). Early retirement from work was tracked through national registers during a period of 5 years. Cox proportional hazard models were used to examine the association of diagnostic groups with risk of early retirement.

Results

In models adjusted for age, sex and socioeconomic position, the relative risk of early retirement for patients with personality disorders was 3.5-fold (95% CI 2.1 to 5.8) in the rehabilitation cohort and 2.3-fold (95% CI 1.6 to 3.5) in the hospital cohort compared with anxiety disorders. The corresponding hazard ratios of early retirement for personality disorders compared with depressive disorders were 1.1 (95% CI 0.8-1.5) and 1.7 (95% CI 1.4-2.1), respectively.

Conclusions

Personality disorders increase the risk of early retirement at least to an equal extent as depression and more than twice that of anxiety disorders.     

Suicidality in temporal lobe epilepsy: measuring the weight of impulsivity and depression

Objective

The aim of the work described here was to measure the role of psychopathological features, specifically impulsivity and depression, in suicidality in patients with temporal lobe epilepsy (TLE).

Methods

Neuropsychiatric evaluation of 66 outpatients with TLE was performed with the following instruments: a structured clinical interview (Mini International Neuropsychiatric Interview Plus), the Barratt Impulsiveness Scale, the Hamilton Anxiety Scale, the Beck Depression Inventory, and the Brief Psychiatric Rating Scale.

Results

A current Axis I psychiatric diagnosis, mainly mood and anxiety disorders, was assigned to 37 subjects (56.1%) Presence of suicide risk was identified in 19 patients (28.8%), and 14 (21.2%) had attempted suicide. Frequency of seizures (P = 0.012), current major depression (P = 0.001), and motor impulsivity (P = 0.005) were associated with suicide risk on univariate analysis. Logistic regression stressed the main relevance of major depression (OR = 12.82, 95% CI = 2.58-63.76, P = 0.002) and motor impulsivity (OR = 1.21, 95% CI = 1.06-1.38, P = 0.005) to suicide risk.

Conclusion

Depression has a major influence on suicidality in epilepsy. Motor impulsivity is also relevant and may be an important component of depression in TLE associated with suicide risk.     

Patients’ subjective initial response and the outcome of inpatient and day hospital treatment

Objective

This study aimed to establish whether psychiatric patients’ subjective initial response (SIR) to hospital and day hospital treatment predicts outcomes over a one-year follow-up period.

Method

We analysed data from 765 patients who were randomised to acute psychiatric treatment in a hospital or day hospital. SIR was assessed on day 3 after admission. Outcomes were psychiatric symptom levels and social disability at discharge, and at 3 and 12 months after discharge.

Results

After controlling for socio-demographic and clinical characteristics, a more positive SIR was significantly associated with lower symptom levels at discharge and 3 months after discharge and lower social disability at 3 months and 12 months after discharge.

Conclusion

SIR can predict outcomes of complex interventions over a one-year period. Patients’ initial views of acute hospital and day treatment should be elicited and considered as important.     

Variation in use of coercive measures in psychiatric hospitals

Purpose

The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels.

Methods

Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18-70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals.

Results

Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics ‘size of the hospital’, ‘length of inpatient stay’, and ‘work load of the nursing staff’ were only weak (‘bed occupancy rate’ was not statistically significant).

Conclusion

The significant variation in use of coercive measures across psychiatric hospitals needs further study.     

Risk factors for late-onset seizures related to cerebral contusions in adults with a moderate traumatic brain injury

Objectives

This prospective study compares the characteristics of patients with a moderately severe traumatic brain injury (TBI) and cerebral contusions who develop late-onset seizures to those who do not.

Patients and methods

Thirty-nine adult TBI patients with cerebral contusions, who did not need a neurosurgical treatment, could be followed up for more than 3 years. Fourteen patients developed seizures during that period and 25 did not. The Glasgow Coma Scale (GCS) score on admission and the modified Rankin (mR) score on discharge from the hospital, the computed tomography (CT) and/or magnetic resonance imaging (MRI) findings, the electroencephalogram (EEG) patterns as well as the vascular and habit risk factors were compared between both groups.

Results

The mean GCS and mR scores were moderately severe and comparable between both groups. Early-onset seizures represented 21.4%. The overall seizure recurrence was 85.7% after treatment with carbamazepine or valproate sodium. Still 3 patients did not remain seizure-free after addition of another antiepileptic drug. The average number of brain contusions on CT/MRI was approximately the same. Vascular risk factors and alcohol abuse were more observed in the seizure patients. Abnormal EEG findings on discharge from the hospital were significantly more frequent in the patients who developed late-onset seizures afterward (P < 0.05).

Conclusions

Seizures after non-complicated cerebral contusions are difficult to treat. Vascular risk factors and alcohol abuse may also predispose to their occurrence. The EEG findings after the TBI are highly predictive.     

Effects of microbubbles on transcranial Doppler ultrasound-assisted intracranial urokinase thrombolysis

Introduction

To evaluate the efficacy of microbubbles in transcranial Doppler ultrasound (TCD)-assisted urokinase thrombolysis.

Materials and Methods

Male New Zealand white rabbits (N = 32) were randomly divided into 2 groups, a urokinase group and a combined urokinase plus microbubble group. The middle cerebral artery (MCA) was occluded by injecting autologous blood clots through the carotid artery. In the urokinase plus microbubble group, sulfur hexafluoride (SonoVue) microbubbles were injected intravenously immediately after intravenous injection of urokinase. The 2 groups were monitored by TCD from before until 2 h after thrombolysis, and the hemodynamic changes and infarct size were recorded.

Results

The urokinase alone group had 1 case of complete recanalization and 4 cases of partial recanalization (recanalization rate, 31.3%). The urokinase plus microbubble group had 3 cases of complete recanalization and 6 cases of partial recanalization (recanalization rate, 56.3%). The average size of the infarction foci was 13.9% in the urokinase group and 9.1% in the urokinase plus microbubble group (P = 0.025). Pathological examination revealed no cerebral hemorrhage in either group.

Conclusions

The addition of microbubbles enhanced the effects of transcranial Doppler ultrasound-assisted urokinase thrombolysis.     

A case-control study provides evidence of association for a common SNP rs974819 in PDGFD to coronary heart disease and suggests a sex-dependent effect

Introduction

Peden et al. have revealed a significant association between four new risk loci and coronary heart disease (CHD) in Europeans and South Asians. The goal of this study is to evaluate the contribution of these genetic loci to CHD risk in Han Chinese.

Methods

We recruited 161 CHD patients and 112 controls proved by angiography originated from Ningbo in the Eastern China, and performed a case-control association study of the four significant SNPs.

Results

Among the four tested SNPs, we found a significant association of rs974819 in PDGFD gene with CHD (allele p = 0.04; OR = 1.45, 95% CI = 1.02 - 2.08) and the allele A/G of rs974819 shows significant difference in females (allele p = 0.04; OR = 1.83, 95% CI = 1.01 - 3.31). A further meta-analysis showed that rs974819 of PDGFD gene was significantly associated with an increasing risk of CHD (OR = 1.08, 95% CI = 1.05 - 1.11) in both Europeans and South Asians including Han Chinese.

Conclusions

Our findings suggests that rs974819 of PDGFD is also a CHD risk factor in Han Chinese. In addition, it presents a sex-dependent genetic effect.     

Alteration in surface muscle electrical anisotropy in the rat SOD1 model of amyotrophic lateral sclerosis

Objective

To evaluate the effects of progressive neurogenic change on surface-measured anisotropy via study in the rat superoxide dismutase 1 (SOD1) G93A amyotrophic lateral sclerosis (ALS) model.

Methods

Eight male ALS rats were studied over a period of 10 weeks. In each, the 20 kHz to 1 MHz electrical impedance of the gastrocnemius-soleus complex was measured with electrodes placed at 0° and at 90° relative to the major muscle fiber direction. The major outcome measure, the anisotropy difference (AD) for each of the resistance, reactance, and phase, was calculated as 90-0° values.

Results

All three parameters showed substantial alterations with disease progression. However, the phase AD demonstrated the most substantial change, increasing from 1.8 ± 1.58° to 10.2 ± 2.13° (mean ± standard error) comparing the first and last set of measurements (p = 0.028).

Conclusions

Anisotropy increases substantially with disease progression in the ALS rat.

Significance

Measurement of surface electrical anisotropy offers a non-invasive means for quantifying neurogenic change in muscle.     

Sunshine-exposure variation of human striatal dopamine D2/D3 receptor availability in healthy volunteers

Background

In addition to the serotonergic system, the central dopaminergic system has been reported to be correlated with seasonality. The aim of this study was to explore the difference in striatal dopamine D₂/D₃ receptor availability between healthy volunteers who had a high-sunshine exposure and those who had a low exposure.

Methods

Sixty-eight participants were enrolled, and those in the upper and lower quartiles in terms of sunshine exposure were categorized into high- (n = 17) and low-sunshine-exposure (n = 18) subgroups. Single photon emission computed tomography with [¹²³I] iodo-benzamide was used to measure striatal dopamine D₂/D₃ receptor availability.

Results

Striatal dopamine D₂/D₃ receptor availability was significantly greater in the subjects with high-sunshine exposure than in those with low-sunshine exposure (F = 7.97, p = 0.01) after controlling for age, sex, and smoking status.

Limitations

Different subjects were examined at different time points in our study. In addition, the sex and tobacco use distributions differed between groups.

Conclusion

The central dopaminergic system may play a role in the neurobiological characteristics of sunshine-exposure variation.     

High kurtosis of intracranial electroencephalogram as a marker of ictogenicity in pediatric epilepsy surgery

Objective

We determined whether kurtosis analysis of intracranial electroencephalogram (EEG) can estimate the localization of the epileptogenic zone.

Methods

We analyzed 29 pediatric epilepsy patients who underwent intracranial EEG before focal resective surgery. We localized the brain regions with high kurtosis, the seizure onset zone (SOZ) and the regions with high-rate, high-amplitude and long-duration interictal paroxysms ?20 Hz. We tested correlations between the surgical resection of those regions and post-surgical seizure outcome, and correlations between kurtosis and the rate/amplitude/duration of interictal paroxysms.

Results

The resection of the regions with high kurtosis correlated with 1-year post-surgical seizure outcome (p = 0.028) but not with 2-year outcome. Kurtosis showed more significant correlation with 1-year seizure outcome than the SOZ and the rate/amplitude/duration of interictal paroxysms. Kurtosis showed positive, independent correlations with the amplitude and duration of interictal paroxysms (p < 0.0001) but not with the rate (p = 0.4).

Conclusions

The regions with high kurtosis provide more reliable information to predict seizure outcome than the SOZ and the regions with high-rate/amplitude and long-duration interictal paroxysms. Kurtosis reflects combined effects of the amplitude and duration of the interictal paroxysms.

Significance

High kurtosis suggests the regions with acquired ictogenicity within the irritative zone.     

Microsurgical management of tuberculum sellae meningiomas by the frontolateral approach: surgical technique and visual outcome

Objectives

The aim of this study was to evaluate visual outcome in patients with tuberculum sellae meningioma (TSM) treated microsurgically using the frontolateral or fronto-orbital approach and optic canal unroofing to resect tumor involvement of the optic canal.

Methods

Data from 67 patients with TSMs who underwent microsurgical treatment by a frontolateral approach (n = 44) or fronto-orbital approach (n = 23) between January 2002 and December 2008 were retrospectively collected and analyzed. Change in visual function was evaluated as the main outcome.

Results

Total tumor resection was achieved in 62 of 67 cases (92.4%). Postoperative, visual acuity was improved in 87 eyes (64.9%) and unchanged in 39 eyes (29.1%), and the optic nerve was therefore preserved in 126 of 134 eyes (94.0%). Visual field deficits were improved or stable in 65 eyes, no patient experienced worsening of vision in both eyes. There was no mortality in our series.

Conclusions

The frontolateral approach with microsurgical dissection of the Sylvian fissure provides quick access to TSMs, which can be resected safely and totally. Visual function is improved and neurological and ophthalmological morbidity is minimal. Optic nerve decompression by intradural clinoidectomy and optic canal unroofing is likely to increase the rate of reducing or eliminating preoperative visual symptoms.     

Decreased serum BDNF levels in major depressive patients

Background

Brain-derived neurotrophic factor (BDNF) plays an important role in neuronal plasticity. The aim of the present study was to measure serum BDNF levels in depression and to analyze the relationship between BDNF levels and severity of depression.

Methods

Thirty patients meeting the DSM-IV criteria for major depressive disorder and 40 normal control subjects were recruited for this study. Patients had not used psychotropic drugs. The severity of depression was assessed by the Hamilton Rating of Depression Scale (HAM-D). Serum BDNF levels were determined by using ELISA.

Results

HAM-D scores were 17.09 ± 4.96 in depressed patients. We determined that the serum BDNF levels of the depression patients were lower than those of the healthy control group (respectively, 1453.42 ± 144.51 pg/ml, 1632.23 ± 252.93 pg/ml, t = 3.467, p = 0.001, independent t test). No correlation was found between the patients’ serum BDNF levels and HAM-D scores (p > 0.05, Pearson correlation analysis).

Conclusions

Our results suggest that serum BDNF levels are low in depression. However it was not found association between serum BDNF levels and the severity of depression.     

Brain derived neurotrophic factor, cardiopulmonary fitness and cognition in patients with coronary artery disease

Objective

To assess serum brain derived neurotrophic factor (BDNF) concentrations as a correlate of cardiopulmonary fitness and as a predictor of cognitive performance in subjects with coronary artery disease (CAD).

Methods

Serum BDNF concentrations were assayed by ELISA and fitness was assessed using a standardized exercise stress test. The Mini Mental Status Examination (MMSE), California Verbal Learning Test 2nd Ed., Stroop, Trail Making Test B and the Digit Symbol-Coding task were administered. The val66met BDNF genotype and serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations were determined as potential confounders.

Results

In subjects with CAD (n = 88; 85.2% male, mean age 62.8 ± 10.5 yr), cardiopulmonary fitness was associated with higher serum BDNF concentrations (β = .305, p = .013). Higher serum BDNF concentrations were associated with higher MMSE scores (F(1, 87) = 15.406, p < .0005) and better performance on the Digit Symbol-Coding task (F(1, 87) = 9.620, p = .003). IL-6, TNF-α and the val66met genotype did not influence these results.

Conclusion

Serum BDNF concentrations were associated with cardiopulmonary fitness, psychomotor processing speed and overall cognition in subjects with CAD.     

Circulating microparticles and risk of venous thromboembolism

Introduction

Circulating microparticles (MPs) may trigger a hypercoagulable state, leading to thrombotic complications. Data on their association with venous thromboembolism (VTE) are few and inconsistent.

Materials and methods

To investigate whether or not high levels of MPs are associated with an increased risk of VTE, we carried out a case-control study on 186 patients with a first, objectively diagnosed, episode of VTE and 418 healthy controls. Plasma levels of circulating MPs were measured by flow cytometry.

Results

Patients had higher median plasma levels of total MPs than controls (2184 per μL vs 1769 per μL, p < 0.0001). The risk of VTE increased progressively with increasing MPs, with a linear dose-response effect in the log odds. Individuals with MPs above the 90th percentile of the controls’ distribution (P₉₀ = 3263 per μL) had a 5-fold increased risk of VTE than those with MPs below the 10th percentile of controls (P₁₀ = 913 per μL), independently of sex, age, body mass index, thrombophilia, and plasma factor VIII levels [adjusted odds ratio: 5.30 (95%CI: 2.05-13.7)]. Using the 95th percentile of controls as cut-off (P₉₅ = 4120 per μL), the adjusted odds ratio was 2.20 (1.01-4.79) for individuals with MPs > P₉₅ compared with those having MPs ≤ P₉₅. After exclusion of individuals with antiphospholipid antibodies and hyperhomocysteinemia, the interaction between MPs > P₉₅ and thrombophilia increased the VTE risk from 1.63 (0.60-4.50) to 6.09 (1.03-36.1).

Conclusions

High levels of circulating MPs are a possible independent risk factor for VTE.     

Efficacy and bleeding risk of antithrombin supplementation in septic disseminated intravascular coagulation: A prospective multicenter survey

Introduction

Although supplementation with antithrombin (AT) concentrates has been widely accepted for the treatment of disseminated intravascular coagulation (DIC) in Japan, the effects and adverse effects have not been investigated.

Materials and Methods

We conducted a nonrandomized multi-institutional survey. A total of 729 septic DIC patients with AT activity levels of 70% or lower, who had undergone AT substitution at either 1500 IU/day or 3000 IU/day for consecutive 3 days were analyzed. Of these, 650 and 79 patients had received 1500 IU/day (AT1500 group) and 3000 IU/day (AT3000 group), respectively.

Results

Bleeding events were observed in 6.52% of patients (severe bleeding, 1.71%). A significant decrease in initial AT level (below 50%) was observed in 69.6% of patients in AT3000 group and 48.2% in AT1500 group, and this difference was significant (P < 0.01). A logistic-regression analysis conducted using age, gender, body weight, initial AT activity, and supplemented AT dose, revealed that higher initial AT activity (odds ratio (OR), 1.032; P < 0.001), AT dose of 3000 IU/day (OR, 1.912; P = 0.026), and age (OR, 0.985; P = 0.023) were significant factors for improved survival.

Conclusion

The risk of severe bleeding is less than 2%, and concomitant administration of heparin did not increase the risk. The survival in AT1500 group was 65.2%, while that in AT3000 group was 74.7%.     

A pilot study of antipsychotic prescribing decisions for acutely-Ill hospitalized patients

Background

Evidence on antipsychotic prescribing decisions is limited. This pilot study quantified factors considered in choosing an antipsychotic and evaluated the influence of metabolic status on treatment decisions.

Methods

Prescribing decisions by 4 psychiatrists were examined based on 80 adult patients initiated on antipsychotic medication diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder by DSM-IV criteria, who were admitted to an acute inpatient psychiatric program of an urban Veterans Affairs Medical Center. The primary analysis examined the association between antipsychotic treatment choice and predictions of symptom control and metabolic risk. Secondary analyses included comparison of the chosen and next best treatments in predicted symptom control and metabolic risk, the frequency of reasons cited for drug choice, and the association between treatment choice and patients' baseline metabolic parameters. Mean differences and odds-ratios (OR) with 95% confidence intervals were used to compare relationships between treatment choice, ratings of risk and metabolic data.

Results

Antipsychotic choice correlated significantly with ratings of predicted symptom control (OR = .92, p = 0.02) and metabolic risk (OR = .88, p = 0.01). Mean differences between the chosen and next best drugs were significant but small in predicted symptom control (F = 2.81, df = 3, 76; p < 0.05) compared with larger differences in anticipated metabolic risk (F = 14.80, df = 3, 76; p = 0.0001). Nevertheless, among 24 identified reasons influencing drug selection, anticipated metabolic risk of chosen antipsychotics was cited less often than efficacy measures. In contrast to psychiatrists' expectations of metabolic risk with selected treatments, we found that patients' actual baseline BMI, fasting glucose, blood pressure, and Framingham risk levels did not necessarily predict antipsychotic treatment choice independent of other factors.

Conclusion

In the context of an acute psychiatric hospitalization, pilot data suggest that predictions of symptom control and metabolic risk correlated significantly with antipsychotic choice, but study psychiatrists were willing to assume relative degrees of metabolic risk in favor of effective symptom control. However, prescribing decisions were influenced by numerous patient and treatment factors. These findings support the potential utility of the ATCQ questionnaire in quantifying antipsychotic prescribing decisions. Further validation studies of the ATCQ questionnaire could enhance translation of research findings and application of treatment guidelines.     

In adults with Prader-Willi syndrome, elevated ghrelin levels are more consistent with hyperphagia than high PYY and GLP-1 levels

Objective

Prader-Willi syndrome (PWS) is a leading genetic cause of obesity, characterized by hyperphagia, endocrine and developmental disorders. It is suggested that the intense hyperphagia could stem, in part, from impaired gut hormone signaling. Previous studies produced conflicting results, being confounded by differences in body composition between PWS and control subjects.

Design

Fasting and postprandial gut hormone responses were investigated in a cross-sectional cohort study including 10 adult PWS, 12 obese subjects matched for percentage body fat and central abdominal fat, and 10 healthy normal weight subjects.

Methods

PYY[total], PYY[3-36], GLP-1[active] and ghrelin[total] were measured by ELISA or radioimmunoassay. Body composition was assessed by dual energy X-ray absorptiometry. Visual analog scales were used to assess hunger and satiety.

Results

In contrast to lean subjects (p < 0.05), PWS and obese subjects were similarly insulin resistant and had similar insulin levels. Ghrelin[total] levels were significantly higher in PWS compared to obese subjects before and during the meal (p < 0.05). PYY[3-36] meal responses were higher in PWS than in lean subjects (p = 0.01), but not significantly different to obese (p = 0.08), with an additional non-significant trend in PYY[total] levels. There were no significant differences in self-reported satiety between groups, however PWS subjects reported more hunger throughout (p = 0.003), and exhibited a markedly reduced meal-induced suppression of hunger (p = 0.01) compared to lean or obese subjects.

Conclusions

Compared to adiposity-matched control subjects, hyperphagia in PWS is not related to a lower postprandial GLP-1 or PYY response. Elevated ghrelin levels in PWS are consistent with increased hunger and are unrelated to insulin levels.     

Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: A systematic review of randomized trials

Background

Minimizing bleeding and transfusion is desirable given its cost, complexity and potential for adverse events. Concerns have been heightened by recent data demonstrating that bleeding events may predict worse outcomes and by warnings about the safety of erythropoietic stimulating agents. Prior small studies suggest that antifibrinolytic agents may reduce bleeding and transfusion need in patients undergoing total hip replacement (THR) or total knee arthroplasty (TKA). However, no single study has been large enough to definitively determine if these agents are safe and effective. To address this issue we performed a systematic review of randomized trials describing the use of tranexamic acid, epsilon aminocaproic acid, or aprotinin administration in the perioperative setting.

Methods

MEDLINE, EMBASE, CINAHL and the Cochrane databases were searched for relevant trials. Two independent reviewers abstracted total blood loss, transfusion requirements, and venous thromboembolism (VTE) rates. Data were combined using the Mantel-Haenszel method and dichotomous data expressed as relative risk (RR) with 95% confidence intervals (CI).

Results

Patients receiving antifibrinolytic agents had reduced transfusion need (RR 0.52; 95% CI, 0.42 to 0.64; P < 0.00001), reduced blood loss and no increase in the risk of VTE (RR 0.95% CI, 0.80 to 1.10, I² = 0%, P = 0.531).

Conclusions

We conclude that antifibrinolytic agents may reduce bleeding and transfusion in patients undergoing THR or TKA who receive appropriate antithrombotic prophylaxis. There is a need for a large, adequately powered prospective study to carefully examine the safety and efficacy of these agents.