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Systematic reviews as a tool for planning and\ud interpreting trials

By Philip M.W. Bath and Laura J. Gray

Abstract

Background Systematic reviews followed by ameta-analysis\ud are carried out in medical research to combine the results of two or more related studies. Stroke trials have struggled to show beneficial effects and meta-analysis should be used more widely throughout the research process to either speed up the development of useful interventions, or halt more quickly research with hazardous or ineffective interventions.\ud \ud Summary of review. This review summarises the clinical research process and illustrates how and when systematic\ud reviews may be used throughout the development programme.\ud Meta-analyses should be performed after observational\ud studies, preclinical studies in experimental stroke, and\ud after phase I, II, and III clinical trials and phase IV clinical surveillance studies. Although meta-analyses most commonly work with summary data, they may be performed to assess relationships between variables (meta-regression) and, ideally, should utilise individual patient data. Meta-analysis techniques may alsoworkwith ordered categorical outcome data (ordinal meta-analysis) and be used to perform indirect comparisons where original trial data do not exist.\ud \ud Conclusion Systematic review/meta-analyses are powerful\ud tools in medical research and should be used throughout\ud the development of all stroke and other intervention

Year: 2009
OAI identifier: oai:eprints.nottingham.ac.uk:1077
Provided by: Nottingham ePrints

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  1. Abciximab Emergent Stroke Treatment Trial (AbESTT) Investigators. Emergency treatment of Abciximab for treatment of patients with acute ischemic stroke. Results of a randomized phase 2 trial .
  2. Adjusted indirect meta-analysis of aspirin plus warfarin at international normalized ratios 2 to 3 versus aspirin plus clopidogrel after acute coronary syndromes. doi
  3. Anticoagulants for acute ischaemic stroke.
  4. Antiplatelet therapy for acute ischaemic stroke.
  5. Blood pressure reduction and cariovascular prevention: An update including the 2003-2004 secondary prevention trials. doi
  6. (2001). Calcium antagonists for acute ischemic stroke.
  7. Dipyridamole for preventing recurrent ischemic stroke and other vascular events: a meta-analysis of individual patient data from randomized controlled trials.
  8. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials.
  9. (2007). Emergency administration of abciximab for the treatment of patients with acute ischemic stroke: results of an international phase III trial. Abciximab in emergency treatment of stroke trial (AbESTT-II). Stroke
  10. (2002). Excitatory amino acid antagonists for acute stroke (Cochrane Review). The Cochrane Library.
  11. Glyceryl trinitrave vs. control, and continuing vs. stopping temporarily prior antihypertensive therapy, in acute stroke: rationale and design of the Efficacy of Nitric Oxide in Stroke (ENOS) trial (ISRCTN99414122).
  12. Glycine antagonist in neuroprotection for patients with acute stroke. GAIN Americas: a randomized controlled trial.
  13. High blood pressure in acute stroke and subsequent outcome: a systematic review.
  14. Intravenous Magnesium Efficacy in Stroke (IMAGES) Study Investigators. Magnesium for acute stroke (Intravenous Magnesium Efficacy in Stroke trial): randomised controlled trial.
  15. Low-molecular-weight heparins and heparinoids in acute ischemic stroke - A meta-analysis of randomized controlled trials.
  16. Lubeluzole for acute ischaemic stroke.
  17. (1993). Meta-analysis of the literature or of individual patient data: is there a difference? Lancet doi
  18. Nimodipine in animal model experiments of focal cerebral ischemia.
  19. Nitric oxide synthase inhibitors in experimental stroke and their effects on infarct size and cerebral blood flow; a systematic review. Free Rad.Biol.Med. doi
  20. on behalf othe IST-3 Collaborative Group. Third International Stroke Trial.
  21. (2006). Optimising the analysis of stroke prevention trials (OAST-P): assessment using ordered rather than dichotomous outcomes?
  22. Oral citicoline in acute ischemic stroke. An individual patient data pooling analysis of clinical trials.
  23. Pooling of animal experimental data reveals influence of study design and publications bias.
  24. propentofylline and pentifylline for acute ischaemic stroke.
  25. Selfotel in acute ischemic stroke. Possible neurotoxic effects of an NMDA antagonist.
  26. Stroke Therapy Academic Industry Roundtable (STAIR). Recommendations for standards regarding preclinical neuroprotective and restorative drug development. Stroke 1999;30:2752-
  27. (2005). Systematic review of nitric oxide donors and L-arginine in experimental stroke; effects on infarct size and cerebral blood flow. Nitric Oxide
  28. Systematic reviews of animal experiments.
  29. The Abciximab in Ischemic Stroke Investigators. Abciximab in acute Ischemic Stroke. A randomised, double-blind, placebo-controlled, dose-escalation study.
  30. The ATLANTIS ECASS and NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
  31. The Optimising Analysis of Stroke Trials (OAST) Collaboration. Can we improve the statistical analysis of stroke trials? Statistical re-analysis of functional outcomes in stroke trials. doi
  32. (2002). The Tirilazad International Steering Committee. Tirilazad for acute ischaemic stroke.
  33. (2003). Thrombolysis for acute ischaemic stroke. Cochrane Database Systematic Review
  34. Tinzaparin in acute ischaemic stroke (TAIST): a randomised aspirin-controlled trial.
  35. Tissue plasminogen activator for acute ischemic stroke in clinical practice: a meta analysis of safety data.
  36. (2002). Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database of Systematic Reviews
  37. Validity of indirect compariosn for estimating efficacy of competing interventions: empirical evidence from published meta-analyses. doi

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