RESUMO
Spontaneous neck hematoma is a rare but life threatening condition which poses a challenge in clinical decision making. With the unsupervised outpatient use of oral anticoagulants, including newer generation ones and the thromboprophylaxis in Covid-19 treatment protocol, the risk of developing spontaneous neck hematoma is high. In this context, our case series aimed at studying the clinicopathological profile, treatment options and outcome in patients presented with spontaneous neck hematoma in a tertiary care center. A retrospective chart review was done between the years 2010-2021, and three cases of spontaneous neck hematoma associated with anticoagulation therapy were identified. Based on our experience, we recommend a custom tailored approach to management of spontaneous neck hematoma.
RESUMO
BACKGROUND: Clinical studies of patients with type 2 diabetes show that GLP-1 receptor agonists (GLP-1 RAs) improve glycemic control and promote weight loss. We conducted a Bayesian network meta-analysis (NMA) of placebo- and active-controlled randomized trials to assess the comparative effectiveness of liraglutide, albiglutide, dulaglutide, and exenatide twice daily and once weekly, with a focus on glycemic control. MATERIALS AND METHODS: We searched Medline, Embase, and the Cochrane Library (up to December 2014) for core registration programs for US-approved GLP-1 RAs. Patients reaching an A1C target of <7% were analyzed with a binomial model and change in A1C from baseline with a normal model. A covariate analysis assessed the impact of baseline A1C and treatment background on outcomes. RESULTS: The base-case NMA used 23 trials reporting A1C outcomes at ~6 month follow-up. The results, unadjusted and adjusted for baseline A1C, indicated that all GLP-1 RAs resulted in statistically significantly lower A1C at follow-up compared with placebo. The odds of reaching the <7% target were also significantly better compared with placebo. With dulaglutide, exenatide once weekly, and liraglutide, the absolute reduction in A1C at 6 months was 0.9%-1.4%, and was significantly better than exenatide twice daily. Albiglutide was not significantly different from exenatide twice daily. We estimate that ~50% of patients will meet the <7% A1C target within 6 months of commencing GLP-1 RAs. CONCLUSION: This was a comprehensive assessment of the comparative effectiveness of GLP-1 RAs and A1C outcome. GLP-1 RAs are a viable addition to oral antidiabetes therapy, and dulaglutide, exenatide once weekly, and liraglutide are the most effective.
