European Journal of Clinical Pharmacology最新文献

{"title":"Attitudes, barriers, and facilitators toward tools supporting appropriate prescribing among healthcare professionals: a cross-sectional study.","authors":"Monia Donati, Valentina Giunchi, Giulia Grillini, Marco Domenicali, Maria Lia Lunardelli, Veronica Pasini, Susy Milandri, Monica Mussoni, Fabio Pieraccini, Elisa Sangiorgi, Emanuel Raschi, Valentina Colonnello, Carlotta Lunghi, Elisabetta Poluzzi","doi":"10.1007/s00228-025-03852-4","DOIUrl":"10.1007/s00228-025-03852-4","url":null,"abstract":"<p><strong>Purpose: </strong>Potentially inappropriate prescriptions are associated with an increased risk of drug-drug interactions, adverse events, and unfavorable clinical outcomes, especially in older adults. Although different tools to improve appropriate prescribing have been developed to support healthcare professionals, their application and the barriers to their use remain insufficiently explored. This study aimed to assess Italian healthcare professionals' knowledge of these tools and identify obstacles to their adoption.</p><p><strong>Methods: </strong>The study used a purposefully designed questionnaire to assess knowledge, adoption, and barriers related to appropriateness tools. The tools included were identified through a literature review and subsequently refined via expert consensus. Open-ended responses were analyzed using a conventional content analysis approach, and the analyses focused on differences across professional groups.</p><p><strong>Results: </strong>The survey collected 657 responses from pharmacists (35%), nurses (26%), general practitioners (22%), geriatricians/internists (9%), and other physicians (8%). The Beers and STOPP/START criteria were used by 38% and 34% of participants, respectively, with geriatricians and other physicians being the primary users. Additionally, 34% of participants reported using specific software integrated into their institutional computer systems. Among 294 respondents identifying barriers to appropriate prescribing, the most common were lack of time (14%), lack of knowledge (10%), and accessibility/costs of digital tools (8%). Key facilitators included specific training (38%), integrated software/apps (29%), and more time with patients (11%).</p><p><strong>Conclusions: </strong>The adoption of tools supporting appropriate prescribing remains limited among healthcare professionals in Italy, with significant differences among professionals. Policymakers and healthcare institutions should focus on education, interprofessional collaboration, and user-friendly digital solutions to improve prescribing process and patient safety.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1155-1165"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disproportionality analysis of serotonin syndrome associated with selective serotonin reuptake inhibitors: a pharmacovigilance analysis.","authors":"Taelim Choi, Jeongseon Oh, Jaehyeong Cho, Jaeyu Park, Tae Hyeon Kim, Jiseung Kang, André Hajek, Jaewon Kim, Selin Woo, Yerin Hwang, Dong Keon Yon","doi":"10.1007/s00228-025-03856-0","DOIUrl":"10.1007/s00228-025-03856-0","url":null,"abstract":"<p><strong>Purpose: </strong>The incidence and risk of serotonin syndrome associated with selective serotonin reuptake inhibitors (SSRIs) have increased. However, large-scale studies investigating this relationship remain limited. Therefore, this study aims to evaluate the signal detection between six SSRIs and serotonin syndrome, rank their relative risks, and propose practical preventive strategies.</p><p><strong>Methods: </strong>This study utilized the global pharmacovigilance database, which systematically compiles adverse drug reaction reports from over 140 countries. The analysis focused on individuals diagnosed with serotonin syndrome associated with SSRIs, classified under the Anatomical Therapeutic Chemical code 'N06AB' and categorized into six types. A disproportionality analysis was conducted using the information component (IC) with IC_0.25 and the reporting odds ratio (ROR) with 95% confidence interval (CI) to assess the signal detection between serotonin syndrome and SSRIs.</p><p><strong>Results: </strong>Among 35 million reports, 24,674 reports of serotonin syndrome were identified from 1968 to 2024, including 4,035 associated with SSRIs. Sertraline (24.46%) was the most frequently implicated SSRI. All SSRIs indicated a significant signal detection with serotonin syndrome, with citalopram exhibited the highest signal (ROR: 77.29 [95% CI, 71.63-83.40]; IC: 6.13 [IC₀₂₅, 6.01]). Hyperthermia and neurological manifestations were the most prevalent. The median time to onset was one day. Recovery rate was 62.21%, and mortality was 0.25%.</p><p><strong>Conclusion: </strong>The findings underscore the potential signal detection between SSRIs and serotonin syndrome. Results also highlight the need to strengthen prevention and management to mitigate associated risks, while long-term studies on serotonin syndrome are essential for improving patient safety and optimizing treatment.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1167-1175"},"PeriodicalIF":2.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pentoxifylline uses in inner ear diseases.","authors":"Ahmed Ramzi, Subhia Maya, Nadeen Balousha, Mufreh Amin, Rovan Ahmed Rouby, Ghalia Aljarrah, Dalia Gamal Elnady, Ahmed Samir, Thoria Ibrahim Essa Ghanm, Zahraa Natheer Bhaya, Abdallah Altarras, Fares Abdelsalam, Mohamed Yasser, Mahmoud Samir, Mostafa Ramzi Shiha","doi":"10.1007/s00228-025-03844-4","DOIUrl":"10.1007/s00228-025-03844-4","url":null,"abstract":"<p><strong>Background: </strong>Labyrinth or the inner ear consists of the cochlea (for hearing) and vestibular system (for balance), with disorders affecting hearing, balance, or both, and symptomatology including hearing loss, tinnitus, and vertigo. Regulatory-approved medications for inner ear diseases are rare worldwide relative to the frequency of those diseases. There are no FDA-approved medications for any inner ear disease. This is due to multiple reasons, including the lack of conclusive evidence for various drugs that have been investigated. We aim to contribute to the review endeavor by addressing pentoxifylline (PTX), a medication that has been studied for cochlear and vestibular disorders, yet its efficacy and safety have not been systematically reviewed in a publication.</p><p><strong>Methods: </strong>More than a dozen databases from around the globe were systematically searched, including PubMed, EMBASE, Scopus, Web of Science, Cochrane/CENTRAL, ScienceDirect, Google Scholar, Europe PMC, ICTRP, ClinicalTrials.gov, EU-CTR, PsycInfo, LILACS, WPRIM, IBECS, SciELO, CNKI, VIP, and Wanfang, to methodically compile experimental and analytical studies. Search results are up to January 2025. This work focused on workable reports in which PTX had distinct or attributable results and organized them into overarching categories of vertigo, hearing loss, and tinnitus.</p><p><strong>Results: </strong>Forty studies, including 15 randomized controlled trials (RCTs), were included. Each condition was addressed in seven RCTs, with some overlap. Studies on inner ear vertigo reported significant outcomes for PTX. A large proportion of the literature involved idiopathic sudden sensorineural hearing loss (ISSNHL), but its results were mixed. Studies on tinnitus suggest that PTX has similar efficacy to Ginkgo biloba extract and corticosteroids, two of the most prescribed medications. Adverse events were generally mild and rarely necessitated discontinuation.</p><p><strong>Conclusion: </strong>Pentoxifylline could improve inner ear vertigo and tinnitus. In ISSNHL, results are inconsistent in the context of spontaneous recovery rates, albeit leaning toward ineffectiveness. Over a variety of regimens, it sustained good safety. The rigor and designs of the reports could not produce robust recommendations.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"955-999"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signals from randomized clinical trials predicting hepatotoxicity of flupirtine: systematic review.","authors":"Mahir Fidahic, Emilija Lozo Vukovac, Ewa Balkowiec-Iskra, Darko Krnic, Adriana Andric, Zeljana Margan Koletic, Livia Puljak","doi":"10.1007/s00228-025-03840-8","DOIUrl":"10.1007/s00228-025-03840-8","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to systematically review clinical trials evaluating the flupirtine to identify any biochemical or clinical indicators that could signal serious hepatotoxicity.</p><p><strong>Methods: </strong>This systematic review included randomized controlled trials (RCTs) evaluating flupirtine-containing medicines for any clinical condition. Trials involving any population, comparator, or outcome were considered eligible for inclusion. A comprehensive search was conducted in Embase, MEDLINE, and CENTRAL from their inception until August 14, 2023. The risk of bias (RoB) in the included trials was assessed using Cochrane's 2011 RoB tool. Due to the heterogeneity of the included trials, a meta-analysis could not be performed.</p><p><strong>Results: </strong>A total of 35 trials published between 1983 and 2022 were included in this systematic review, with 1408 participants receiving flupirtine. Only five trials reported any data related to liver function tests. Among these, four trials documented transient, asymptomatic liver abnormalities that returned to normal after the trial period, while one trial was prematurely terminated. One trial reported normal liver test results in all participants. Of the three trials published after 2018, only one acknowledged the withdrawal of flupirtine from the European market. The majority of risk of bias (RoB) domains were classified as having an unclear risk of bias.</p><p><strong>Conclusion: </strong>Published RCTs did not report any evidence of serious hepatotoxicity associated with flupirtine based on the available biochemical or clinical data. However, liver function test results were reported in only 5 out of 35 included trials. Published RCTs are not reliable information about flupirtine-related hepatotoxicity.</p><p><strong>Registration: </strong>Protocol was published in PROSPERO (CRD42018085123).</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1043-1054"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of a medication discrepancy management platform in reducing medication discrepancy and influencing factors among elderly patients with polypharmacy.","authors":"Jingyan Song, Jie Huang, Jian Mao, Jing Cao, Qinghua Zhao","doi":"10.1007/s00228-025-03831-9","DOIUrl":"10.1007/s00228-025-03831-9","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the impact of a medication discrepancy management platform on reducing medication discrepancies among elderly patients with polypharmacy and to analyze influencing factors.</p><p><strong>Methods: </strong>A total of 110 elderly polypharmacy patients were divided into a control group and an observation group using a random number method, each with 55 participants. The control group received routine management, while the observation group utilized a medication discrepancy management platform. Medication knowledge and adherence before and after intervention were compared between the two groups. Reasons and types of medication discrepancies were statistically analyzed. Patients were divided into a non-discrepancy group and a discrepancy group, with multivariate logistic regression used to analyze factors influencing medication discrepancies among elderly patients with polypharmacy.</p><p><strong>Results: </strong>Utilizing a medication discrepancy management platform significantly improved medication knowledge and adherence among elderly patients (P < 0.05). A total of 34 patients (30.91%) experienced at least one medication discrepancy within one-week post-discharge, primarily involving decreased frequency, missed doses, reduction in medication types, and medication substitution. Multivariate logistic regression analysis showed that the use of the medication discrepancy management platform, caregiver involvement, and prescribed discharge medications (7-8 types or ≥ 9 types) were independent factors influencing medication discrepancies in elderly patients (P < 0.05).</p><p><strong>Conclusion: </strong>Using a medication discrepancy management platform can effectively reduce medication discrepancies in elderly patients with polypharmacy and improve elderly patients' adherence to medication. Expanding the platform's use can enhance discharge guidance quality and ensure medication safety.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1017-1027"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of a visualization platform for ADR query and analysis: an example of severe skin adverse reactions caused by sulfonylureas.","authors":"Hui-Min Yu, Ya-Min Huang, Jian Xiao, Lu Zhang, Hang-Xing Huang, Ling Huang, Jing-Yang Li, Xin-Qiong Huang","doi":"10.1007/s00228-025-03842-6","DOIUrl":"10.1007/s00228-025-03842-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop a visualization platform for querying and analysing data from the FDA Adverse Event Reporting System (FAERS) to support the efficient collection, review, and analysis of adverse drug reactions (ADRs) for pharmacovigilance.</p><p><strong>Methods: </strong>Data acquisition, cleaning, and integration processes were conducted to prepare FAERS data for analysis. The platform was designed with key functionalities, including multi-condition query, drug and ADR query, primary ID query, and interactive visualizations. Usability was demonstrated through a case study investigating the association between sulfonylureas and serious skin ADRs. Additionally, the platform's accuracy was validated by comparing its outputs with manually retrieved and visualized data using a separate test case involving aspirin and tremor.</p><p><strong>Results: </strong>The platform provides an interface with advanced query and visualization features, enabling users to efficiently retrieve, analyse, and visualize ADR data. Usability was illustrated by dynamically exploring FAERS data to identify safety signals for sulfonylureas and serious skin ADRs. The validation process confirmed the platform's reliability by showing consistent results with manually processed data, demonstrating its potential to streamline PV workflows and improve data interpretation.</p><p><strong>Conclusion: </strong>The visualization platform represents a novel and practical tool for pharmacovigilance research. By offering intuitive data query and analysis capabilities, the platform supports drug safety monitoring and promotes the development of pharmacovigilance practices.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1055-1067"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signal detection of ferric carboxymaltose-induced serious adverse events: disproportionality analysis of FAERS and VigiBase data and systematic review of case reports.","authors":"Reddikumar Reddy Galigutta, Christy Thomas, Mahesh Rathod, P N Hasik, R S Ray, Jai Prakash, Krishna Undela","doi":"10.1007/s00228-025-03849-z","DOIUrl":"10.1007/s00228-025-03849-z","url":null,"abstract":"<p><strong>Purpose: </strong>The recent surge in serious adverse events (SAEs) and deaths associated with ferric carboxymaltose (FCM) underscores the importance of evaluating its safety profile.</p><p><strong>Methods: </strong>We conducted a retrospective case/non-case study from Q4 of 2003 to Q4 of 2024 data on FCM in the FDA Adverse Event Reporting System (FAERS) and VigiBase databases. Signal detection was performed using proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). The influence of concomitant medication on the identified signal was assessed and refined using Open Vigil 2.1. Additionally, to identify case reports on FCM-induced adverse events, a comprehensive search was performed in PubMed, Google Scholar, and Scopus databases from inception to April 12, 2025.</p><p><strong>Results: </strong>In the FAERS database, 46 deaths were reported in connection with FCM, though no significant death signal was observed (PRR = 0.3, LB (lower bound) ROR = 0.2, IC₀₂₅ = - 2.3). Nonetheless, positive safety signals emerged for SAEs such as anaphylactic shock (PRR = 3.9, LB ROR = 2.3, IC₀₂₅ = 1.0), circulatory collapse (PRR = 14.6, LB ROR = 10.5, IC₀₂₅ = 3.1), respiratory distress (PRR = 9.6, LB ROR = 7.1, IC₀₂₅ = 2.6), hypophosphatemia (PRR = 520.7, LB ROR = 530.1, IC₀₂₅ = 8.0), and arrhythmia (PRR = 3.3, LB ROR = 2.2, IC₀₂₅ = 1.0). After meticulously refining our analysis to account for the influence of concomitant medications, we observed that the strength of all signals remained unchanged, except for respiratory distress, bradycardia, hypotension, abdominal pain, and urticaria. Analysis of VigiBase data revealed 42 reported fatal cases and potential signals for hypersensitivity (PRR = 4.5, LB ROR = 4.4, IC₀₂₅ = 2.1), anaphylactic shock (PRR = 2.3, LB ROR = 1.9, IC₀₂₅ = 0.9), circulatory collapse (PRR = 7.2, LB ROR = 6.0, IC₀₂₅ = 2.5), respiratory distress (PRR = 6.9, LB ROR = 5.7, IC₀₂₅ = 2.5), and hypophosphatemia (PRR = 245.1, LBROR = 234.8, IC₀₂₅ = 7.5) with Ferinject. The systematic review of 11 case reports emphasized SAEs linked to FCM, thereby strengthening this association.</p><p><strong>Conclusion: </strong>This study reveals that FCM carries SAEs. Providers must weigh the benefits and risks on a case-by-case basis, considering patient-specific factors. Continuous monitoring and further research are crucial for the safe use of FCM in iron deficiency anemia.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1081-1096"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purine xanthine oxidase inhibitors are not conducive to the prognosis of chronic heart failure: a meta-analysis.","authors":"Lin Ye, Anyi Xu, Jianing Huang, Yeyuan Zhang, Jie Yao, Fang Wang","doi":"10.1007/s00228-025-03848-0","DOIUrl":"10.1007/s00228-025-03848-0","url":null,"abstract":"<p><strong>Background: </strong>According to previous studies, the efficacy of xanthine oxidase inhibitors (XOIs) in patients with chronic heart failure (CHF) is still controversial. Therefore, the purpose of this study was to investigate the efficacy of XOIs in patients with CHF.</p><p><strong>Methods: </strong>Up to July 2024, we searched PubMed, EMBASE, Medline, Web of Science, and Cochrane Library for studies on the efficacy of XOI in patients with CHF. The main results included all-cause mortality, cardiovascular (CV) mortality, and heart failure (HF) hospitalization rates. The results were evaluated by hazard ratio (HR) and 95% confidence interval (95% CI).</p><p><strong>Results: </strong>A total of eight studies were included in this meta-analysis, of which five were cohort studies and three were randomized controlled trials (RCTs). The total sample size was 301,345. The experimental group was exposed to allopurinol or hydroxypurinol. The all-cause mortality (HR = 1.26, 95% CI 1.05-1.51, p = 0.013) and CV mortality (HR = 1.58, 95% CI 1.17-2.14, p = 0.03) in the experimental group were higher than those in the control group. In terms of HF hospitalization, there was no difference between both groups (HR = 1.21, p = 0.292). Subgroup analysis showed that the CV hospitalization rate of the experimental group was higher than that of the control group, regardless of frequency and dose levels. The all-cause mortality in the low-dose group was higher than that in the control group (HR = 1.39, p = 0.033). The CV mortality of the low-dose group (HR = 1.55, p = 0.006) and the prevalent group (HR = 1.50, p = 0.042) was higher than that of the control group.</p><p><strong>Conclusion: </strong>Purine XOI exposure may be unfavorable for the prognosis of CHF patients and is affected by the frequency and dose of use.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1069-1079"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antithrombotic therapy for secondary stroke prevention in patients with cancer: a systematic review and network meta-analysis.","authors":"Leonardo Zumerkorn Pipek, Rafaela Farias Vidigal Nascimento, Sabrina Isabel Coronel, Mark Baker, Fernando Mayor Basto, Guilherme Diogo Silva","doi":"10.1007/s00228-025-03847-1","DOIUrl":"10.1007/s00228-025-03847-1","url":null,"abstract":"<p><strong>Background: </strong>The risk of stroke among patients with cancer is two times that of the general population due to a combination of cancer-, chemotherapy-, radiotherapy-, and surgery-related factors. There is a paucity of data regarding the optimal antithrombotic therapy for secondary stroke prevention in these patients.</p><p><strong>Objectives: </strong>Our goal was to review the stroke recurrence in patients treated with different antithrombotic therapies (antiplatelets, warfarin, heparin, and direct oral anticoagulants). Our secondary objective was to review the bleeding risk across different antithrombotic therapies.</p><p><strong>Methods: </strong>A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles that adequately assessed secondary prevention of stroke in patients with cancer were selected from the PubMed, Embase, and Scopus databases from inception until March 2, 2025. We performed a network meta-analysis for stroke recurrence, major bleeding, and mortality. The treatments were ranked by P-SCORE. Subgroup analyses were conducted based on median D-dimer levels, multiple territories of stroke, and exclusion of studies with high risk of bias.</p><p><strong>Results: </strong>We included 11 studies (four RCTs, six retrospective studies, and one case series) with a total of 1319 patients. In the primary analysis, antiplatelets were the highest-ranked treatment for reducing stroke recurrence (RR 0.44 [0.20; 0.96]), followed by LMWH (RR 0.50 [0.26; 0.96]), both significantly superior to no treatment. However, LMWH consistently ranked higher than antiplatelets in all subgroup analyses. There was no difference regarding major bleeding or mortality.</p><p><strong>Conclusion: </strong>Antiplatelets can be considered an option for secondary prevention of stroke in patients with cancer, especially in patients with a higher bleeding risk. Future research with high-quality studies is needed to confirm our preliminary findings and should focus on identifying subgroups of patients with cancer who may benefit most from specific antithrombotic therapies.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"1001-1015"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring risk assessment tools for medicine-related problems among culturally and linguistically diverse patients in Australia: a systematic review.","authors":"Rawan Sawalha, Sarah Al-Samawy, Zeyad Mahmoud, Chloe Tadorian, Christopher Levi, Neil Spratt, Hassan Hosseinzadeh, Beata Bajorek","doi":"10.1007/s00228-025-03845-3","DOIUrl":"10.1007/s00228-025-03845-3","url":null,"abstract":"<p><strong>Purpose: </strong>This review evaluated publications that described medicine risk assessment tools developed or adapted for use in Australia to assess risks associated with medicine-related problems (MRPs). It examined whether these tools considered cultural background as a crucial risk factor for MRPs and whether clinical guidelines provided tailored recommendations for Culturally and Linguistically Diverse (CALD) patients.</p><p><strong>Methods: </strong>A systematic search was conducted in Web of Science, Scopus, CINHAL, EMBASE, PubMed/Medline and Google Scholar (January 1985-November 2024). The review included publications on the development or validation of medicine risk assessment tools for MRPs in Australia, as well as clinical guidelines relevant to managing diseases classified as National Health Priority Areas (NHPAs).</p><p><strong>Results: </strong>Sixteen publications on thirteen medication risk assessment tools and thirteen publications on twelve clinical therapeutic guidelines were included. Risk factors varied widely and were categorised into four groups: patient-related (e.g. age, cognitive status), disease-related (e.g. comorbidities), medicine-related (e.g. polypharmacy), and health services-related (e.g. re-hospitalisations). Only one tool considered CALD background as a risk factor for MRPs. Although some tools acknowledged non-adherence or communication issues, they did not systematically address underlying cultural or linguistic factors. Clinical guidelines primarily focused on self-management and providing information in CALD patients' first language, with some encouraging interpreter use.</p><p><strong>Conclusion: </strong>Medicine risk assessment tools lack consistent frameworks, and CALD backgrounds are largely overlooked as a key demonstrated risk factor for MRPs. Future research should develop inclusive tools and clinical guidelines incorporating cultural and linguistic factors. Policymakers and healthcare practitioners should refine these tools to improve medication safety and achieve equitable healthcare outcomes for CALD populations.</p>","PeriodicalId":11857,"journal":{"name":"European Journal of Clinical Pharmacology","volume":" ","pages":"913-938"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}