The association of platelets with failed patent ductus arteriosus closure after a primary course of indomethacin or ibuprofen: a systematic review and meta-analysis. (17th January 2017)

• Record Type: Journal Article
• Authors: Mitra, Souvik; Chan, Anthony K.; Paes, Bosco A.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 30:Number 2(2017)
• Page Start: 127
• Page End: 133
• Publication Date: 2017-01-17
• Subjects: Closure -- failed primary therapy -- ibuprofen -- indomethacin -- patent ductus arteriosus -- meta-analysis; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.3109/14767058.2016.1163684
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective : To conduct a meta-analysis of the association of platelet counts and pharmacotherapeutic failure in preterms with a patent ductus arteriosus (PDA). Methods : MEDLINE, Embase, Science Citation Index, abstracts and conference proceedings were searched, and principal authors contacted. Included studies reported indomethacin or ibuprofen use for PDA closure, compared a group which failed treatment versus a group which did not and reported the association between platelet counts and indomethacin or ibuprofen failure. Two reviewers independently screened results and assessed methodological quality using the Newcastle-Ottawa Scale. Results are expressed as mean difference in platelet counts and summary odds ratios (OR) using a random effects model. Results : 1105 relevant studies were identified; eight involving 1087 preterms were included. Platelet counts were significantly lower in infants who failed pharmacotherapy (Meandifference:–30.88 × 10 9 /L; 95% CI:–45.69 × 10 9, –16.07 × 10 9 /L; I2 = 24%; pheterogeneity = 0.24). Similar results were obtained based on either pharmacotherapeutic agent. Treatment failure was also significantly associated with pre-treatment thrombocytopenia (summary OR:1.75; 95% CI:1.23–2.49, I2 = 36%, pheterogeneity = 0.20). Conclusions : Platelet counts are significantly lower in preterms who fail primary treatment for PDA. Pre-treatment thrombocytopenia is associated with higher odds of failure. Further cohort studies reporting platelet counts in prostaglandin inhibitor failure are needed for meta-analyses to firmly establish or refute a stronger association.