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J. Kowalewski
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-011 - Optimal Strategy to Prevent Atrial Fibrillation in Patients Undergoing Pulmonary Resection for Lung Cancer. Network Meta-Analysis (ID 2383)
09:30 - 09:30 | Author(s): J. Kowalewski
- Abstract
Background:
Atrial fibrillation (AF) after pulmonary resections for lung cancer, although transient in most cases, occurs in up to 30% following lobectomy and up to 65% after pneumonectomy and might, in turn, lead to serious adverse events including stroke, myocardial infarction and death. Different preventive measures have been investigated, however because of paucity of evidence from randomized studies, straightforward recommendations are still uncertain. We aimed to perform a Bayesian-framework mixed treatments comparison (network) meta-analysis of both randomized controlled- (RCTs) and observational studies, to investigate the net-relative benefit of diverse drugs in prevention of atrial fibrillation following pulmonary resections for lung cancer.
Methods:
We screened Medline, Google Scholar, EMBASE and Cochrane CENTRAL registries for randomized and observational studies comparing drugs to each other and/or to placebo. Studies with post-operative AF as prespecified end-point were retrieved for detailed abstraction. Primary outcome was assessed at longest available follow-up.
Results:
Overall 15 studies (13 RCTs) were identified, enrolling N=1753 patients. Beta-blockers, Atrial Natriuretic Peptide and Flecainide were associated with significant relative reduction in odds of postoperative AF, OR (2.5-97.5% CrI) of 0.34 (0.02-0.92); 0.35 (0.00-0.94) and 0.11 (0.00-0.46) respectively; Digoxin was found to increase these odds. Addition of observational data allowed for identification of Amiodarone as another potentially preventive treatment OR (2.5-97.5% CrI) 0.28 (0.03-0.69). Bayesian posterior probability curves revealed the ranking among treatments with Flecainide, beta-blockers, ANP and Amiodarone being associated with the highest probability to reduce the odds of AF, magnesium and calcium blockers with virtually no effect and digoxin found inferior to placebo. Figure 1
Conclusion:
Beta-blockers and Flecainide are effective in reducing the incidence of postoperative AF in patients after pulmonary resections which is not the case with digoxin; data on remaining treatments are sparse and preclude drawing definite conclusions.
