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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Anak Agung Ngurah Gede Anggra Pramana
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Impact of Tocolytic Therapy on Cardiovascular Outcomes in Preterm Labor: A Systematic Review and Meta-Analysis Ni Putu Ika Regiana Maharani; I Gede Agus Rio Saputra; Anak Agung Ngurah Gede Anggra Pramana; I Putu Gede Budiana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1283

Abstract

Background: Preterm labor is a significant cause of neonatal morbidity and mortality, and tocolytic therapy is often used to delay delivery and improve neonatal outcomes. However, tocolytic drugs can have adverse cardiovascular effects, including an increased risk of atrial fibrillation (AF). This meta-analysis aims to evaluate the impact of tocolytic therapy on cardiovascular outcomes in preterm labor, focusing on the risk of AF. Methods: A systematic literature review was conducted following PRISMA guidelines. Relevant studies published between 2013 and 2024 were identified through PubMed, Scopus, ScienceDirect, and Cochrane Library. Studies evaluating the cardiovascular effects of tocolytic therapy in preterm labor were included. The primary outcome was the incidence of AF. Secondary outcomes included other cardiovascular adverse events. Results: Ten studies met the inclusion criteria, comprising 550 pregnant women receiving tocolytic therapy. Tocolytic therapy was associated with a significantly increased risk of AF compared to no tocolytic therapy (mean difference 0.2, 95% CI 0.10-0.30). Nifedipine and ritodrine had a higher risk of AF compared to atosiban. The risk of AF was also higher in patients with pre-existing cardiovascular diseases. Conclusion: Tocolytic therapy, particularly with nifedipine and ritodrine, increases the risk of AF in preterm labor. Atosiban appears to be a safer option for patients with cardiovascular risk factors. Careful consideration of the potential cardiovascular risks and benefits is crucial when making tocolytic therapy decisions.
Impact of Tocolytic Therapy on Cardiovascular Outcomes in Preterm Labor: A Systematic Review and Meta-Analysis Ni Putu Ika Regiana Maharani; I Gede Agus Rio Saputra; Anak Agung Ngurah Gede Anggra Pramana; I Putu Gede Budiana
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 5 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i5.1283

Abstract

Background: Preterm labor is a significant cause of neonatal morbidity and mortality, and tocolytic therapy is often used to delay delivery and improve neonatal outcomes. However, tocolytic drugs can have adverse cardiovascular effects, including an increased risk of atrial fibrillation (AF). This meta-analysis aims to evaluate the impact of tocolytic therapy on cardiovascular outcomes in preterm labor, focusing on the risk of AF. Methods: A systematic literature review was conducted following PRISMA guidelines. Relevant studies published between 2013 and 2024 were identified through PubMed, Scopus, ScienceDirect, and Cochrane Library. Studies evaluating the cardiovascular effects of tocolytic therapy in preterm labor were included. The primary outcome was the incidence of AF. Secondary outcomes included other cardiovascular adverse events. Results: Ten studies met the inclusion criteria, comprising 550 pregnant women receiving tocolytic therapy. Tocolytic therapy was associated with a significantly increased risk of AF compared to no tocolytic therapy (mean difference 0.2, 95% CI 0.10-0.30). Nifedipine and ritodrine had a higher risk of AF compared to atosiban. The risk of AF was also higher in patients with pre-existing cardiovascular diseases. Conclusion: Tocolytic therapy, particularly with nifedipine and ritodrine, increases the risk of AF in preterm labor. Atosiban appears to be a safer option for patients with cardiovascular risk factors. Careful consideration of the potential cardiovascular risks and benefits is crucial when making tocolytic therapy decisions.
A Hierarchy of Harm: A Meta-analysis of Infection, Thrombosis, and Mortality Risks Across Central Catheters, Arteriovenous Grafts, and Fistulas Anak Agung Ngurah Gede Anggra Pramana; Anthony Wijaya; Putu Chandra Wibawa; I Gusti Agung Bagus Krisna Wibawa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1462

Abstract

Background: Vascular access is a critical lifeline for patients with end-stage kidney disease requiring hemodialysis. The optimal choice among central venous catheters (CVCs), arteriovenous grafts (AVGs), and arteriovenous fistulas (AVFs) is a subject of intense debate, as each modality carries a distinct profile of risks. This meta-analysis was performed to establish a definitive, quantitative hierarchy of these risks to better inform clinical and policy decisions. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted for studies published between January 2015 and September 2025 that compared complication rates among CVCs, AVGs, and AVFs in adult hemodialysis patients. Seven high-quality cohort studies met the inclusion criteria, encompassing 18,542 patients. Data on access-related bloodstream infections (ARBSI), access circuit thrombosis/dysfunction, and all-cause mortality were extracted. Pairwise meta-analyses using a random-effects model calculated pooled risk ratios (RR) and 95% confidence intervals (CI). Results: Central venous catheters were associated with a profoundly higher risk of ARBSI compared to both AVFs (RR 8.12, 95% CI 6.98–9.45, p < 0.001) and AVGs (RR 4.55, 95% CI 3.89–5.33, p < 0.001). Arteriovenous grafts demonstrated a markedly higher risk of access circuit thrombosis compared to AVFs (RR 2.78, 95% CI 2.41–3.21, p < 0.001). All-cause mortality was highest in patients with CVCs, showing a significantly increased risk compared to AVF users (RR 1.92, 95% CI 1.68–2.19, p < 0.001). Conclusion: This meta-analysis provides robust, contemporary quantitative evidence for a clear hierarchy of harm in hemodialysis access. CVCs pose the greatest risk for infection and mortality, AVGs present the highest risk for thrombosis, and AVFs represent the safest option. These data provide a powerful rationale for reinforcing systemic healthcare initiatives aimed at minimizing CVC exposure and promoting timely AVF placement.
A Hierarchy of Harm: A Meta-analysis of Infection, Thrombosis, and Mortality Risks Across Central Catheters, Arteriovenous Grafts, and Fistulas Anak Agung Ngurah Gede Anggra Pramana; Anthony Wijaya; Putu Chandra Wibawa; I Gusti Agung Bagus Krisna Wibawa
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1462

Abstract

Background: Vascular access is a critical lifeline for patients with end-stage kidney disease requiring hemodialysis. The optimal choice among central venous catheters (CVCs), arteriovenous grafts (AVGs), and arteriovenous fistulas (AVFs) is a subject of intense debate, as each modality carries a distinct profile of risks. This meta-analysis was performed to establish a definitive, quantitative hierarchy of these risks to better inform clinical and policy decisions. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted for studies published between January 2015 and September 2025 that compared complication rates among CVCs, AVGs, and AVFs in adult hemodialysis patients. Seven high-quality cohort studies met the inclusion criteria, encompassing 18,542 patients. Data on access-related bloodstream infections (ARBSI), access circuit thrombosis/dysfunction, and all-cause mortality were extracted. Pairwise meta-analyses using a random-effects model calculated pooled risk ratios (RR) and 95% confidence intervals (CI). Results: Central venous catheters were associated with a profoundly higher risk of ARBSI compared to both AVFs (RR 8.12, 95% CI 6.98–9.45, p < 0.001) and AVGs (RR 4.55, 95% CI 3.89–5.33, p < 0.001). Arteriovenous grafts demonstrated a markedly higher risk of access circuit thrombosis compared to AVFs (RR 2.78, 95% CI 2.41–3.21, p < 0.001). All-cause mortality was highest in patients with CVCs, showing a significantly increased risk compared to AVF users (RR 1.92, 95% CI 1.68–2.19, p < 0.001). Conclusion: This meta-analysis provides robust, contemporary quantitative evidence for a clear hierarchy of harm in hemodialysis access. CVCs pose the greatest risk for infection and mortality, AVGs present the highest risk for thrombosis, and AVFs represent the safest option. These data provide a powerful rationale for reinforcing systemic healthcare initiatives aimed at minimizing CVC exposure and promoting timely AVF placement.
Co-Authors Anthony Wijaya I GEDE AGUS RIO SAPUTRA I Gusti Agung Bagus Krisna Wibawa I Putu Gede Budiana Ni Putu Ika Regiana Maharani Putu Chandra Wibawa