Subject(s)
Patient Care Team , Pregnancy Complications, Hematologic/therapy , Purpura, Thrombotic Thrombocytopenic/therapy , Adult , Antibodies, Monoclonal, Murine-Derived/adverse effects , Antibodies, Monoclonal, Murine-Derived/therapeutic use , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Cesarean Section , Combined Modality Therapy , Enoxaparin/therapeutic use , Female , Hemorrhage/chemically induced , Heparin/adverse effects , Heparin/therapeutic use , Humans , Infant, Newborn , Interdisciplinary Communication , Laryngeal Edema/chemically induced , Methylprednisolone/therapeutic use , Plasma Exchange , Pregnancy , Pregnancy Complications, Hematologic/drug therapy , Puerperal Disorders/drug therapy , Puerperal Disorders/etiology , Puerperal Disorders/therapy , Pulmonary Embolism/drug therapy , Pulmonary Embolism/etiology , Pulmonary Embolism/therapy , Purpura, Thrombotic Thrombocytopenic/complications , Purpura, Thrombotic Thrombocytopenic/drug therapy , Recurrence , Rituximab , Warfarin/therapeutic useABSTRACT
A multicenter randomized open-label long-term sequential deferipronedeferoxamine (DFP-DFO) versus DFP alone trial (sequential DFP-DFO) performed in patients with thalassemia major (TM) was retrospectively reanalyzed to assess the variation in the left ventricular ejection fraction (LVEF) [1].
Subject(s)
Heart Ventricles/drug effects , Heart Ventricles/physiopathology , Iron Chelating Agents/adverse effects , Pyridones/therapeutic use , beta-Thalassemia/drug therapy , beta-Thalassemia/physiopathology , Adult , Deferiprone , Deferoxamine/administration & dosage , Deferoxamine/therapeutic use , Drug Administration Schedule , Drug Therapy, Combination , Female , Heart Ventricles/diagnostic imaging , Humans , Iron Chelating Agents/administration & dosage , Male , Models, Biological , Pyridones/administration & dosage , Retrospective Studies , Stroke Volume/drug effects , Time Factors , UltrasonographyABSTRACT
Blood transfusions may prevent and treat serious complications related to sickle-cell disease (SCD) when performed according to specific guidelines. However, blood transfusion requirements in SCD inevitably lead to increased body iron burden. An adequate chelation treatment may prevent complications and reduce morbidity and mortality. This review evaluates the effectiveness, safety and costs of chelation treatment. The included trials were examined according to the recommendations of the American College of Cardiology (ACC) and the American Heart Association (AHA). Overall, 14 trials and a total of 502 patients with SCD were included in this review. Deferoxamine alone (s.c. or i.v.), deferiprone alone or versus deferoxamine, deferasirox versus deferoxamine and combined treatment with deferoxamine plus deferiprone were included and evaluated in the analysis. Only two randomized clinical trials have been reported. The results of this analysis suggest that use of chelation treatment in SCD to date has been based on little efficacy and safety evidence, although it is widely recommended and practised. The cost/benefit ratio has not been fully explored. Further research with larger randomized clinical trials needs to be performed.
