Therapeutics and Clinical Risk Management最新文献

{"title":"Low-Dose Dexmedetomidine Reduces Median Effective Doses of Propofol Required for Successful Gastroscope Insertion: A Prospective Randomized Controlled Dose-Finding Trial.","authors":"Qian Zhu, Pei-Pei Hao, Ling-Li Cui, Fu-Kun Liu, Fu-Shan Xue","doi":"10.2147/TCRM.S571057","DOIUrl":"10.2147/TCRM.S571057","url":null,"abstract":"<p><strong>Purpose: </strong>Patients undergoing painless gastrointestinal endoscopy (GIE) typically receive propofol-based sedation. However, the exact dose of propofol when combined with low-dose dexmedetomidine for this procedure remains unclear. The objective of this study was to determine and compare the median effective doses (ED₅₀, the doses required for successful gastroscope insertion in 50% of the subjects) of propofol when used with low-dose dexmedetomidine (0.3 µg/kg) premedication versus propofol alone during painless GIE.</p><p><strong>Patients and methods: </strong>Adult outpatients aged 18 to 65 years scheduled for GIE were enrolled. Participants were randomized to receive either 0.9% saline (Group S) or 0.3 µg/kg of dexmedetomidine (Group D) intravenously over 5 min before induction with propofol. Using modified Dixon's up-and-down method (MDUDM), the initial induction dose of propofol was 1.5 mg/kg, adjusted in a step size of 0.1 mg/kg. ED₅₀ of propofol required for successful endoscope insertion was calculated by averaging the midpoints of all sequential crossovers. Using isotonic regression analysis, ED₅₀ and ED₉₅ (the effective doses required for successful gastroscope insertion in 95% of the subjects) were then extrapolated. All adverse events during painless GIE were recorded.</p><p><strong>Results: </strong>Thirty patients were enrolled per group. Using MDUDM, the ED₅₀ of propofol for successful gastroscope insertion was significantly lower in Group D (1.48 ± 0.10 mg/kg) than in Group S (1.82 ± 0.16 mg/kg; <i>P</i> < 0.001). The ED₅₀ and ED₉₅ of propofol were extrapolated to 1.80 mg/kg (83% confidence interval [CI], 1.649-1.882) and 2.10 mg/kg (83% CI, 2.081-2.124) for Group S, respectively, using isotonic regression analysis. These values were significantly lower in Group D, at 1.40 mg/kg (83% CI, 1.297-1.452) and 1.70 mg/kg (83% CI, 1.667-1.753).</p><p><strong>Conclusion: </strong>Premedication with low-dose dexmedetomidine (0.3 µg/kg) significantly reduces the median effective doses of propofol required for successful gastroscope insertion during painless GIE.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"571057"},"PeriodicalIF":2.6,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487359","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":"Comparison of a Kidney Intensive Care Unit Healthcare-Led Model versus a Traditional Haemodialysis Nurse-Led Model for Continuous Renal Replacement Therapy: A Retrospective Observational Study.","authors":"Ting Zhang, Gaiying Jiang, Huinan Yan, Juzi Wang, Xin Lan, Jianming Bai, Yonghong Deng, Nan Zhang, Qian Gao, Yanting Shen, Xueqing Wang, Ruxian Wei","doi":"10.2147/TCRM.S545995","DOIUrl":"10.2147/TCRM.S545995","url":null,"abstract":"<p><strong>Background: </strong>The optimal organisational model for delivering continuous renal replacement therapy (CRRT) to critically ill patients remains a subject of investigation.</p><p><strong>Objective: </strong>This study compared the impact of a kidney intensive care unit (KICU) healthcare-led model with a traditional haemodialysis nurse-led model on key clinical process indicators and patient outcomes during CRRT.</p><p><strong>Methods: </strong>In this retrospective observational study, patients requiring CRRT admitted to the KICU of a tertiary hospital between January 2022 and December 2023 were selected. Patients were divided into two groups based on the treatment leadership: the KICU group, where CRRT was led by intensive care unit supervising physicians and nurses certified in critical care blood purification techniques, and the control group, led by supervising physicians and haemodialysis nurses. Data were collected via the hospital information system and nursing records. After propensity score matching, 1180 patients were included in each group. Supplementary multivariable regression analyses were performed to provide adjusted effect estimates. Outcomes included treatment interruption rate, catheter-related infection rate, complication rate, actual delivered effluent dose, catheter insertion to treatment initiation time and patient satisfaction.</p><p><strong>Results: </strong>The KICU group demonstrated a significantly lower overall complication rate (1.8% vs 3.7%, <i>p</i> = 0.004) and a higher rate of achieving the prescribed effluent dose (87.7% vs 81.2%, <i>p</i> < 0.001). Time to CRRT initiation was shorter in the KICU group (23.75 ± 2.43 vs 30.60 ± 6.36 minutes, <i>p</i> < 0.05). Patient satisfaction was also higher (<i>p</i> < 0.05). No significant differences were found in treatment interruption or catheter-related infections. The benefits of the KICU model on these key outcomes remained statistically significant in multivariable-adjusted analyses.</p><p><strong>Conclusion: </strong>Continuous renal replacement therapy management by a dedicated KICU multidisciplinary team was associated with a lower complication rate, improved delivery of the prescribed dialysis dose, faster treatment initiation and higher patient satisfaction compared with a traditional model. These findings suggest that a structured, healthcare-led model can optimise the CRRT process for critically ill patients. Further multicentre studies are warranted to confirm these results.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"545995"},"PeriodicalIF":2.6,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487361","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":"Retrospective Analysis: Comparative Effects of General Anesthesia versus Quadratus Lumborum Block-Supplemented General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Myomectomy.","authors":"Ruchun Yan, Man Kuang","doi":"10.2147/TCRM.S561612","DOIUrl":"10.2147/TCRM.S561612","url":null,"abstract":"<p><strong>Background and objective: </strong>This retrospective study analyzed to compare the effects of general anesthesia (GA) versus combined anesthesia (CA) on postoperative pain and negative emotions in patients undergoing uterine fibroid surgery, providing evidence for optimizing anesthesia protocols aiming to achieve more effective analgesia and improve patient satisfaction scores.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on data from 148 patients who underwent uterine fibroid surgery at a tertiary hospital between April 2023 and December 2024. Patients were divided into a control group (GA) and a study group (CA) based on anesthesia type. The control group received conventional GA, while the study group received ropivacaine quadratus lumborum block (QLB) combined with GA. After propensity score matching (PSM), 74 patients were included in each group. The primary outcome was postoperative 2-12h visual analog scale (VAS) pain scores. Secondary outcomes included stress indicators (ACTH, Cor), emotional scales (SAS/SDS), cognitive function (MMSE), and sleep quality (PSQI).</p><p><strong>Results: </strong>The study group had shorter anesthesia duration, postoperative flatus time, postoperative ambulation time, and hospital stay compared to the control group (all P<0.05). VAS scores at 2h, 4h, 8h, and 12h postoperatively were significantly lower in the study group (all P<0.05). Preoperative differences in emotional, stress, cognitive, and sleep indicators were not statistically significant (all P>0.05). Postoperatively, the study group showed significantly lower SAS/SDS scores, ACTH/Cor levels, and PSQI scores, alongside higher MMSE scores compared to the control group (all P<0.05).</p><p><strong>Conclusion: </strong>Combined anesthesia effectively reduces postoperative pain and negative emotions in uterine fibroid patients, lowers stress levels, improves sleep quality, and promotes rapid recovery, making it worthy of clinical promotion.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"561612"},"PeriodicalIF":2.6,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967209","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":"Ultrasound Assessment of Preoperative Gastric Contents for Predicting Aspiration Risk in Surgical Patients: A Scoping Review and Future Directions.","authors":"Yuzhou Li, Li Tang, Shuying Zou, Xiangnan Zhu, Bo Zhang, Caixia Xie","doi":"10.2147/TCRM.S570929","DOIUrl":"10.2147/TCRM.S570929","url":null,"abstract":"<p><strong>Introduction: </strong>This scoping review aims to summarise studies evaluating gastric contents in surgical patients using preoperative ultrasound, discuss current challenges, and propose future directions.</p><p><strong>Methods: </strong>The system retrieved data from 8 databases, including PubMed, with a search period spanning from the inception to May 11, 2025. The scoping review follows the JBI scoping review framework and the PRISMA-ScR reporting guidelines.</p><p><strong>Results: </strong>A total of 44 studies were included. The research involved various perioperative populations and surgical procedures, with a \"full stomach\" rate ranging from 0% to 57.7%. Ultrasound operators included anesthesiologists, sonographers, and medical consultants. Assessment methods comprised qualitative, quantitative, or combined approaches. Evaluation metrics included gastric contents nature, Perlas 3-point grading system, gastric antral cross-sectional area (CSA), and gastric volume.</p><p><strong>Conclusion: </strong>Preoperative gastric ultrasound can provide information about gastric contents, thereby aiding in the identification of aspiration risk and enabling the adoption of appropriate anaesthesia strategies. However, existing studies still face limitations, including restricted study populations and sample sizes, variations in operator training, a lack of consensus on an evaluation metric threshold value, and diverse gastric volume calculation models. Future studies should expand their scale, enhance training for clinicians in gastric ultrasound, and standardise assessment positions, threshold values, and selection criteria for calculation models. Furthermore, we believe that integrating artificial intelligence with gastric ultrasound can overcome the limitations of manual measurement, offering a direction for precise and convenient preoperative assessment of gastric contents.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"570929"},"PeriodicalIF":2.6,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487314","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":"Clinical Outcomes and Safety of Ureteral Catheter-Assisted Antegrade Guidewire Intubation in the Laparoscopic-Endoscopic Rendezvous Procedure for Cholelithiasis with Choledocholithiasis: A Retrospective Cohort Study.","authors":"Binyao Shi, Jiayuan Feng, Peng Hu, Shangdong Lv, Binfeng Wang, Qi Wang, Zheping Fang, Aidong Wang, Wenlong Zhang, Fabiao Zhang","doi":"10.2147/TCRM.S569440","DOIUrl":"10.2147/TCRM.S569440","url":null,"abstract":"<p><strong>Background and purpose: </strong>The laparoscopic-endoscopic rendezvous procedure, which integrates laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography (ERCP), is an established therapeutic strategy for patients with cholelithiasis and concomitant choledocholithiasis. This study evaluated the impact of ureteral catheter-assisted antegrade guidewire intubation on the procedural success rate and duration of the rendezvous technique, with additional assessment of safety and clinical efficacy.</p><p><strong>Methods: </strong>Clinical data were retrospectively analyzed from patients with cholelithiasis and concomitant choledocholithiasis who underwent laparoscopic cholecystectomy at the South Campus of Taizhou Hospital (Enze Hospital), Zhejiang Province, between May 2019 and December 2022. A total of 116 patients were assigned to either a control group or an intervention group in which ureteral catheter-assisted guidewire insertion was employed.</p><p><strong>Results: </strong>The success rate of antegrade guidewire intubation was 98.3% in the intervention group, compared to 91.2% in the control group. The intervention group demonstrated a statistically significant reduction in guidewire insertion time (<i>p</i> < 0.05). No statistically significant differences were observed between groups in terms of intraoperative hospitalization costs, total hospitalization duration, postoperative serum amylase levels or postoperative hospitalization duration (<i>p</i> > 0.05). The total operative duration tended to be lower but did not reach statistical significance in the intervention group compared to the control group, with a p-value of 0.054. No cases of postoperative bile leakage were reported. In the control group, the incidence of acute pancreatitis was 2%, and the incidence of hyperamylasemia was 28.8%. In the intervention group, hyperamylasemia occurred in 25.9% of cases, with no reported instances of acute pancreatitis. Additionally, one patient in the control group developed a pulmonary embolism, and two patients developed ascites accompanied by fever.</p><p><strong>Conclusion: </strong>The use of ureteral catheter-assisted antegrade guidewire intubation during the laparoscopic-endoscopic rendezvous procedure appears to be a safe and clinically effective approach for managing cholelithiasis and concomitant choledocholithiasis. This technique is associated with a high success rate of guidewire realignment, reduced procedural duration, and a lower incidence of procedure-related complications.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"569440"},"PeriodicalIF":2.6,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487382","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":"A Narrative Review and Risk-Stratification Framework for Preventing LNG-IUS Expulsion in Adenomyosis.","authors":"Jin Zhao, Jianliang Chen, Xiaoe Wang, Huabin Wang","doi":"10.2147/TCRM.S566786","DOIUrl":"10.2147/TCRM.S566786","url":null,"abstract":"<p><p>Levonorgestrel-releasing intrauterine system (LNG-IUS) expulsion rates are markedly elevated (15-37.5%) in patients with adenomyosis compared to those with normal uteri (3-10%), significantly compromising treatment efficacy and adherence. Existing evidence on risk factor mitigation is fragmented, lacking a structured management framework. This narrative review synthesizes current literature to identify key determinants of expulsion-including uterine enlargement, intracavitary lesions, and insertion techniques-and evaluates preventive strategies such as GnRH-agonist pretreatment and imaging-guided placement. Its primary aim is to propose a novel, three-tiered risk-stratification model that tailors management (conventional, augmented, or advanced fixation approaches) to individual patient profiles based on anatomical, procedural, and clinical factors. This structured approach seeks to optimize LNG-IUS retention and resource allocation. Prospective validation through randomized controlled trials remains essential to establish evidence-based, personalized protocols.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"22 ","pages":"566786"},"PeriodicalIF":2.6,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12998664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487354","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":"Prehospital Tranexamic Acid Combined with Blood Transfusion Reduced the Short-Term Mortality Risk in Trauma Patients at Risk for Hemorrhage.","authors":"Zheng Qian, Bining Yang","doi":"10.2147/TCRM.S564232","DOIUrl":"10.2147/TCRM.S564232","url":null,"abstract":"<p><strong>Background: </strong>Hemorrhage is a leading cause of preventable death in trauma. While both blood transfusion and tranexamic acid (TXA) improve outcomes, the combined effect of prehospital TXA and transfusion remains uncertain. This study aims to evaluate the impact of prehospital TXA combined with blood transfusion on short-term mortality in trauma patients at risk for hemorrhage.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 408 adult trauma patients at risk for hemorrhage admitted between 2018 and 2023. Patients were grouped into transfusion only (n=240) or prehospital TXA plus transfusion (n=168). The primary outcome was 30-day mortality. Secondary outcomes included 24-hour mortality, transfusion requirements, multiple organ failure (MOF), and venous thromboembolism (VTE).</p><p><strong>Results: </strong>Compared with transfusion alone, prehospital TXA plus transfusion significantly reduced 30-day mortality (14.3% vs 31.3%, p<0.01) and 24-hour mortality (6.0% vs 19.6%, p<0.01). The TXA group also had lower MOF incidence (14.3% vs 28.7%, p<0.01) and required less plasma and crystalloid resuscitation, without an increase in VTE (p=0.17). Kaplan-Meier analysis confirmed a survival advantage (log-rank p<0.01), and multivariate Cox regression identified combination therapy as an independent predictor of reduced 30-day mortality (HR=2.16, 95% CI: 1.35-3.46, p<0.01).</p><p><strong>Conclusion: </strong>Prehospital TXA combined with transfusion significantly improves short-term survival and reduces organ failure in bleeding trauma patients, without increasing thromboembolic risk. These findings support early integration of TXA into prehospital transfusion protocols.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1915-1921"},"PeriodicalIF":2.8,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145912740","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":"Safety and Efficacy of Intra-Osseous versus Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis.","authors":"Mengjie Cai, Yu Dai","doi":"10.2147/TCRM.S549510","DOIUrl":"10.2147/TCRM.S549510","url":null,"abstract":"<p><strong>Background: </strong>The immediate administration of drugs and fluids is critical for successful resuscitation in out-of-hospital cardiac arrest (OHCA). Vascular access selection plays a pivotal role in ensuring timely delivery of therapeutic interventions during OHCA management. This study aims to compare the safety and efficacy of intraosseous (IO) and intravenous (IV) access in OHCA management.</p><p><strong>Methods: </strong>We conducted a comprehensive search of PubMed, EMbase, Google Scholar, and the Cochrane Library databases to identify studies published up to February 20th, 2025, evaluating IO and IV access in OHCA patients. The outcomes of interest included return of spontaneous circulation (ROSC), survival from hospital admission to discharge, neurological outcome, comorbidities, and access time.</p><p><strong>Results: </strong>Twenty-three studies, comprising 48945 cases of IO access and 188966 cases of IV access for OHCA management, were included. Overall, the rate of favorable neurological outcome was similar between patients with IO and IV access (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.37 to 1.45, I²=95.3%). IO access was associated with significantly lower odds of shockable rhythms in both adult (OR = 0.77; 95% CI = 0.70 to 0.85, I²=86%) and pediatric (OR = 0.20; 95% CI = 0.12 to 0.33) patients. Additionally, IO access was linked to a lower rate of ROSC in pediatric OHCA patients (OR = 0.30; 95% CI = 0.21 to 0.42). Prospective studies and those with unadjusted time to intervention analysis demonstrated markedly lower rates of survival at discharge, favorable neurological outcome, and ROSC in the IO group compared to the IV group. It should also be noted that the interpretation of the results should take into account the high heterogeneity and potential biases, despite the corresponding subgroup analyses we conducted.</p><p><strong>Conclusion: </strong>In OHCA management, IO access may be associated with less favorable outcomes in terms of survival, neurological function, and ROSC compared to IV access. Further research is needed to address limitations and provide more robust evidence regarding the comparative effectiveness of intraosseous and intravenous access in this clinical setting.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1887-1903"},"PeriodicalIF":2.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901088","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":"Safety and Efficacy Comparison of Ticagrelor versus Other P2Y12 Inhibitors in Combination with Oral Anticoagulants as a Part of DAPT/SAPT in Patients with Concomitant Atrial Fibrillation and Coronary Artery Disease: A Meta-Analysis.","authors":"Yang Li, Jing Gong, Naifeng Liu","doi":"10.2147/TCRM.S575007","DOIUrl":"10.2147/TCRM.S575007","url":null,"abstract":"<p><strong>Objective: </strong>We performed a meta-analysis of randomized controlled trials to assess the safety and efficacy of ticagrelor or other P2Y12 inhibitors in combination with oral anticoagulants as a part of DAPT/SAPT for the patients with atrial fibrillation (AF) and acute coronary disease (ACS) or undergoing percutaneous coronary intervention (PCI).</p><p><strong>Methods: </strong>We searched PubMed, Web of Science and ClinicalTrials.gov for randomized controlled trials (published from January 1, 1998, up to June 6, 2023; no language restrictions) comparing safety and efficacy of ticagrelor and DOACs or VKAs combination treatment arm with or without aspirin to other P2Y12 inhibitors treatment strategies. Main endpoints were clinically relevant bleeding as safety outcomes, all-cause mortality, and major adverse cardiovascular events (MACE) as efficacy outcomes.</p><p><strong>Results: </strong>Of 248 identified studies, 3 were eligible and were included in our analysis (N= 9463 participants). Ticagrelor and DOAC or VKA combination treatment with or without aspirin strategy was associated with an increased rate of bleeding compared with clopidogrel (odds ratio [OR] 1.39, 95% CI 1.15 to 1.67, I²=0%). MACE was similar between ticagrelor versus clopidogrel (OR 1.00, 95% CI 0.54 to 1.86, I²=68.1%) and between ticagrelor versus prasugrel (OR 0.86, 95% CI 0.28 to 2.65, I²=0%).</p><p><strong>Conclusion: </strong>The use of ticagrelor is associated with significantly higher rates of bleeding when compared with clopidogrel in patients with concomitant atrial fibrillation and coronary artery disease.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1905-1913"},"PeriodicalIF":2.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145912690","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":"Electroacupuncture as a Non-Pharmacological Intervention for Nicotine Dependence: Evidence from a Randomized Clinical Trial.","authors":"Zhen Lai, Qian Fan, Ai Ling Lee, Xujing Yao, Ranran Dai, Yan Liang","doi":"10.2147/TCRM.S565463","DOIUrl":"10.2147/TCRM.S565463","url":null,"abstract":"<p><p>Nicotine dependence, a chronic addictive disorder characterized by high relapse rates, represents a significant global public health challenge. This study employed a randomized, single-blind, parallel-group controlled design to systematically evaluate the efficacy and safety of electroacupuncture compared with varenicline in the treatment of nicotine dependence. The results demonstrated that electroacupuncture achieved significantly superior outcomes across multiple key outcome measures relative to varenicline: the electroacupuncture group exhibited a greater mean daily reduction in Fagerström Test for Nicotine Dependence (FTND) scores (-1.11 points/day vs -0.33 points/day, P < 0.001) and a higher rate of sustained improvement at the 3-month follow-up (84.4% vs 69.5%). With respect to the Heaviness of Smoking Index (HSI), the electroacupuncture group showed a more rapid and sustained decline (sustained rate: 81.7% vs 63.9%, P = 0.002). Moreover, electroacupuncture demonstrated significant advantages in alleviating nicotine withdrawal symptoms (sustained rate: 75.3% vs 52.8%, P = 0.026) and reducing daily cigarette consumption (79.0% vs 56.2%, P < 0.001). The potential mechanism may involve modulation of the mesolimbic dopamine system. These findings support electroacupuncture as a safe, effective, and sustainable non-pharmacological intervention for smoking cessation, particularly suitable for individuals with high nicotine dependence who are sensitive to adverse drug reactions or exhibit poor medication adherence, and suggest its potential role as a complementary or alternative strategy in clinical smoking cessation programs. Future research should further validate its long-term efficacy and investigate the neurobiological mechanisms underlying its effects on relapse prevention.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"1869-1885"},"PeriodicalIF":2.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12764299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901128","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}