Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1 T8, Canada.
Syst Rev. 2013 Jun 28;2:45. doi: 10.1186/2046-4053-2-45.
Patients undergoing surgery or chemotherapy often experience nausea and vomiting. To increase their quality of life and treatment satisfaction, antiemetic medication, such as serotonin receptor antagonists, is often prescribed for patients experiencing these symptoms. However, early warning signs suggest that serotonin receptor antagonists can cause harm, including arrhythmia. Our objective is to identify the most effective interventions that mitigate the risk of adverse cardiac events associated with serotonin receptor antagonists in patients undergoing surgery and chemotherapy through a systematic review and network meta-analysis.
METHODS/DESIGN: We will search electronic databases (for example, MEDLINE, Embase) from inception onwards, as well as dissertations and governmental reports, to identify interventions (for example, telemetry, electrocardiography, electrolyte monitoring) that decrease the cardiac risk associated with serotonin receptor antagonists among surgery and chemotherapy patients. Eligible comparators include placebo or supportive care; eligible study designs are experimental studies (randomized controlled trials (RCTs), quasi-RCTs, non-RCTs), non-experimental studies (interrupted time series, controlled before-and-after studies), and cohort studies. Outcomes of interest include arrhythmia, sudden cardiac death, QT prolongation, PR prolongation, and all-cause mortality. We will include unpublished studies and studies published in languages other than English.Draft inclusion and exclusion criteria will be established and pilot tested amongst the team. Subsequently, two team members will screen the results in duplicate and resolve conflicts through discussion. The same process will be followed to screen full-text articles, data abstraction, and appraise quality or risk of bias. To determine validity of results, experimental and quasi-experimental studies will be assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) Risk of Bias tool, while cohort studies will be appraised using the Newcastle-Ottawa Scale. We anticipate sufficient data and homogeneity to conduct random effects meta-analysis and network or mixed treatment comparisons meta-analysis, if appropriate.
Our results will provide information regarding the utility of different strategies that can be used to mitigate cardiac risk amongst patients taking serotonin antagonist receptors. Such results are likely to be of use to clinicians prescribing these agents, as well as policy makers responsible for making decisions about antiemetic medications.
PROSPERO registry number: CRD42013003565.
接受手术或化疗的患者常经历恶心和呕吐。为提高患者生活质量和治疗满意度，经常为出现这些症状的患者开具止吐药物，如 5-羟色胺受体拮抗剂。然而，早期预警信号表明，5-羟色胺受体拮抗剂可能会造成伤害，包括心律失常。我们的目标是通过系统评价和网络荟萃分析，确定减轻手术和化疗患者使用 5-羟色胺受体拮抗剂相关不良心脏事件风险的最有效干预措施。
方法/设计：我们将从成立开始，在电子数据库（例如 MEDLINE、Embase）以及论文和政府报告中进行搜索，以确定干预措施（例如遥测、心电图、电解质监测），以降低手术和化疗患者使用 5-羟色胺受体拮抗剂的心脏风险。合格的对照包括安慰剂或支持性护理；合格的研究设计包括实验研究（随机对照试验（RCT）、准 RCT、非 RCT）、非实验研究（中断时间序列、对照前后研究）和队列研究。感兴趣的结局包括心律失常、心脏性猝死、QT 间期延长、PR 间期延长和全因死亡率。我们将纳入未发表的研究和用英语以外的语言发表的研究。将制定草案的纳入和排除标准，并在团队中进行试点测试。随后，两名团队成员将对结果进行重复筛选，并通过讨论解决冲突。将采用相同的流程筛选全文文章、数据提取和评估质量或偏倚风险。为了确定结果的有效性，实验和准实验研究将使用 Cochrane 有效实践和组织护理（EPOC）偏倚风险工具进行评估，而队列研究将使用纽卡斯尔-渥太华量表进行评估。我们预计会有足够的数据和同质性来进行随机效应荟萃分析和网络或混合治疗比较荟萃分析，如果合适的话。
我们的研究结果将提供有关不同策略的信息，这些策略可以用于减轻接受 5-羟色胺拮抗剂受体治疗的患者的心脏风险。这些结果可能对开具这些药物的临床医生以及负责制定止吐药物政策的决策者有用。
PROSPERO 注册号：CRD42013003565。
