Comparing pharmacological venous thromboembolism prophylaxis to intermittent pneumatic compression in acute intracerebral haemorrhage: protocol for a systematic review and network meta-analysis

Abstract

IntroductionPatients with an intracerebral haemorrhage are at increased risk of venous thromboembolism. Pharmacotherapy and pneumatic compression devices are capable of preventing venous thromboembolism, however both interventions have limitations. There are no head-to-head comparisons between these two interventions. To address this knowledge gap, we plan to perform a systematic review and network meta-analysis to examine the comparative effectiveness of pharmacological prophylaxis and mechanical compression devices in the context of intracerebral haemorrhage.Methods and analysisMEDLINE, PUBMED, EMBASE, CENTRAL, ClinicalTrials.gov and the Internet Stroke Trials Registry will be searched with assistance from an experienced information specialist. Eligible studies will include those that have enrolled adults presenting with spontaneous intracerebral haemorrhage and compared one or more of the respective interventions against each other and/or a control. Primary outcomes to be assessed are occurrence of new venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) and haematoma expansion, defined as a significant enlargement of baseline haemorrhage or new haemorrhage occurrence. Both randomised and non-randomised comparative studies will be included. Data on participant characteristics, study design, intervention details and outcomes will be extracted. Study quality will be assessed using the Cochrane Risk of Bias Tool and the Robins-I tool. Bayesian network meta-analyses will be performed to compare interventions based on all available direct and indirect evidence. If the transitivity assumption for network meta-analysis cannot be met, we will perform a qualitative assessment.Ethics and disseminationFormal ethics is not required as primary data will not be collected. The findings of this study will be disseminated through conference presentations, and peer-reviewed publications. In an area of clinical practice where equipoise exists, the findings of this study may assist in determining which treatment intervention is most effective in venous thromboembolism prevention.PROSPERO registration numberCRD42018090960.

Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mellitus: a systematic review and Bayesian network meta-analysis

“…Second, we did a Bayesian network analysis by using Markov chain Monte Carlo methods via GeMTC package 0.8 implemented in R 3.2.2. We also assessed study design information and patient characteristics to evaluate the transitivity assumption for reliable data pooling with sufficient similarity between the included trials [18, 19]. Both non-informative uniform and normal prior distributions were used throughout the network meta-analysis [20].…”

“…We then reported the results of the random-effects model. Brooks-Gelman-Rubin diagnostic plot was used to assess model convergence of network analysis [19]. We also ranked the different treatments in terms of lowering the HbA1c% level using the same methods [20].…”

Venous Thromboembolism in ICU Patients with Intracerebral Hemorrhage: Risk Factors and the Prognosis After Anticoagulation Therapy

“…At present, prophylactic approaches include anticoagulation and IPC, which are recommended for VTE prevention in ICH patients. 15 , 16 , 25 However, there are little data on the treatment of VTE in ICH patients. 20 Anticoagulation therapy for VTE complications in ICH patients varies widely across different ICH management guidelines.…”

“…Prophylactic approaches, such as intermittent pneumatic compression (IPC) and heparin, are recommended for the VTE prevention after ICH. 15,16 Meanwhile, according to American Heart Association/ American Stroke Association (AHA/ASA) and Chinese Stroke Association guidelines for ICH, systemic coagulation or inferior vena cava (IVC) filter placement is recommended in ICH patients with symptomatic DVT or PE (Class IIa; Level of Evidence C). 17,18 However, European Stroke Organization (ESO) guidelines do not have explicit recommendations for VTE after ICH.…”

Venous thromboembolism prevention in intracerebral hemorrhage: A systematic review and network meta-analysis

“…The protocol for this study was registered with PROSPERO (CRD42018090960) and published [14]. This study was conducted using recommendations from the Cochrane Handbook for Systematic Reviews, and findings were prepared with guidance from the PRISMA extension statement for network meta-analysis [15].…”