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Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis

BACKGROUND: Evidence comparing fibrin sealants (FSs) in surgery are limited. This study evaluated the efficacy and safety of FSs, and manual compression in peripheral vascular surgery. METHODS: A systematic review of randomized trials was conducted in Medline, Embase, and Cochrane databases within t...

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Detalles Bibliográficos
Autores principales: Danker III, Walter, DeAnglis, Ashley, Ferko, Nicole, Garcia, David, Hogan, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782199/
https://www.ncbi.nlm.nih.gov/pubmed/33425351
http://dx.doi.org/10.1016/j.amsu.2020.12.003
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author Danker III, Walter
DeAnglis, Ashley
Ferko, Nicole
Garcia, David
Hogan, Andrew
author_facet Danker III, Walter
DeAnglis, Ashley
Ferko, Nicole
Garcia, David
Hogan, Andrew
author_sort Danker III, Walter
collection PubMed
description BACKGROUND: Evidence comparing fibrin sealants (FSs) in surgery are limited. This study evaluated the efficacy and safety of FSs, and manual compression in peripheral vascular surgery. METHODS: A systematic review of randomized trials was conducted in Medline, Embase, and Cochrane databases within the last 15 years. Data were available to conduct a network meta-analysis (NMA) in peripheral vascular surgery. Fibrin sealant treatment arms were further broken-down and assessed by clotting time (i.e., 2-min [2C] or 1-min [1C]). The primary efficacy outcome was the proportion of patients achieving hemostasis by 4 min (T4). Treatment-related serious and non-serious adverse events (AEs) were qualitatively assessed. RESULTS: Five studies (n = 693), were included in the NMA. Results predicted VISTASEAL 2C, followed by EVICEL 1C, had the highest probability of achieving T4. Compared with manual compression, significant improvements in T4 were found with VISTASEAL 2C (relative risk [RR] = 2.67, 95% CrI: 2.13–3.34), EVICEL 1C (RR = 2.58, 95% CrI: 2.04–3.23), VISTASEAL 1C (RR = 2.00, 95% CrI: 1.45–2.65), and TISSEEL 2C (RR = 1.99, 95% CrI: 1.48–2.60). TISSEEL 1C was not significantly different than manual compression (RR = 1.40, 95% CrI: 0.70–2.33). Among FSs, VISTASEAL 2C was associated with a significant improvements in T4 compared with VISTASEAL 1C (RR = 1.33, 95% CrI: 1.02–1.82), TISSEEL 2C (RR = 1.34, 95% CrI: 1.05–1.77), and TISSEEL 1C (RR = 1.90, 95% CrI: 1.18–3.74). Treatment-related serious and non-serious AE rates were typically lower than 2%. CONCLUSIONS: In peripheral vascular surgeries, VISTASEAL 2C and EVICEL 1C were shown to have the highest probabilities for achieving rapid hemostasis among the treatments compared. Future studies should expand networks across surgery types as data become available.
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spelling pubmed-77821992021-01-08 Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis Danker III, Walter DeAnglis, Ashley Ferko, Nicole Garcia, David Hogan, Andrew Ann Med Surg (Lond) Review Article BACKGROUND: Evidence comparing fibrin sealants (FSs) in surgery are limited. This study evaluated the efficacy and safety of FSs, and manual compression in peripheral vascular surgery. METHODS: A systematic review of randomized trials was conducted in Medline, Embase, and Cochrane databases within the last 15 years. Data were available to conduct a network meta-analysis (NMA) in peripheral vascular surgery. Fibrin sealant treatment arms were further broken-down and assessed by clotting time (i.e., 2-min [2C] or 1-min [1C]). The primary efficacy outcome was the proportion of patients achieving hemostasis by 4 min (T4). Treatment-related serious and non-serious adverse events (AEs) were qualitatively assessed. RESULTS: Five studies (n = 693), were included in the NMA. Results predicted VISTASEAL 2C, followed by EVICEL 1C, had the highest probability of achieving T4. Compared with manual compression, significant improvements in T4 were found with VISTASEAL 2C (relative risk [RR] = 2.67, 95% CrI: 2.13–3.34), EVICEL 1C (RR = 2.58, 95% CrI: 2.04–3.23), VISTASEAL 1C (RR = 2.00, 95% CrI: 1.45–2.65), and TISSEEL 2C (RR = 1.99, 95% CrI: 1.48–2.60). TISSEEL 1C was not significantly different than manual compression (RR = 1.40, 95% CrI: 0.70–2.33). Among FSs, VISTASEAL 2C was associated with a significant improvements in T4 compared with VISTASEAL 1C (RR = 1.33, 95% CrI: 1.02–1.82), TISSEEL 2C (RR = 1.34, 95% CrI: 1.05–1.77), and TISSEEL 1C (RR = 1.90, 95% CrI: 1.18–3.74). Treatment-related serious and non-serious AE rates were typically lower than 2%. CONCLUSIONS: In peripheral vascular surgeries, VISTASEAL 2C and EVICEL 1C were shown to have the highest probabilities for achieving rapid hemostasis among the treatments compared. Future studies should expand networks across surgery types as data become available. Elsevier 2020-12-09 /pmc/articles/PMC7782199/ /pubmed/33425351 http://dx.doi.org/10.1016/j.amsu.2020.12.003 Text en © 2020 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review Article
Danker III, Walter
DeAnglis, Ashley
Ferko, Nicole
Garcia, David
Hogan, Andrew
Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis
title Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis
title_full Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis
title_fullStr Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis
title_full_unstemmed Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis
title_short Comparison of fibrin sealants in peripheral vascular surgery: A systematic review and network meta-analysis
title_sort comparison of fibrin sealants in peripheral vascular surgery: a systematic review and network meta-analysis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7782199/
https://www.ncbi.nlm.nih.gov/pubmed/33425351
http://dx.doi.org/10.1016/j.amsu.2020.12.003
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