Antiplatelets For Prevention Of Pre-eclampsia: An Individual Patient Data Review
Funder
National Health and Medical Research Council
Funding Amount
$274,000.00
Summary
High blood pressure is a common complication of pregnancy affecting ~20,000 Australian women each year. Although most women and their babies do well, pre-eclampsia, defined as high blood pressure together with protein in the urine is a more serious problem. Severe pre-eclampsia is associated with 10-15% of maternal deaths. Fetal and newborn baby deaths are also increased. Mother and baby morbidity is high principally due to the associated complications in pregnancy, increased obstetric intervent ....High blood pressure is a common complication of pregnancy affecting ~20,000 Australian women each year. Although most women and their babies do well, pre-eclampsia, defined as high blood pressure together with protein in the urine is a more serious problem. Severe pre-eclampsia is associated with 10-15% of maternal deaths. Fetal and newborn baby deaths are also increased. Mother and baby morbidity is high principally due to the associated complications in pregnancy, increased obstetric interventions, fetal growth restriction and preterm birth. As yet we have no safe and effective way of preventing this life threatening condition. Aggregation of platelets (involved in blood clotting) is known to be part of the disease and could lead to the disturbances in the circulation of the mother and the placenta. Antiplatelet agents, low dose aspirin in particular, might prevent or delay the development of pre-eclampsia. Some trials and a Cochrane systematic review of all trials (involving over 30,000 women) suggest that pre-eclampsia, preterm birth and perinatal death could be reduced. However, it is still not clear which women will benefit, when in pregnancy the treatment should start and what dose of aspirin is both effective and safe. This proposed individual patient data review in which data on all women who have been entered in trials is gathered from the original investigators, including missing information on potential harms. This proposal represents a good investment of resources to obtain the information needed by women and health professional to make decisions about the use of aspirin. International investigators from all the primary trials have already formed a collaboration to oversee the project: the Perinatal Antiplatelet Review of International Studies (PARIS) Collaboration Furthermore, working through an international collaboration will ensure the highest quality in data availability, as well endorsement and implementation of the results in practice.Read moreRead less
Extended Follow Up Of The RENAL Study And Individual Patient Data Meta-analysis In Acute Kidney Injury
Funder
National Health and Medical Research Council
Funding Amount
$650,271.00
Summary
Acute kidney failure is increasingly common and associated with very high mortality. The long term consequences for patients and their kidney function are unknown. By extending follow up of the RENAL study, which explored how the dose of dialysis affected survival, and combining it with other trials from around the world, we will provide the strongest evidence regarding how dialysis treatment can reduce this mortality and define the long term consequences of this condition.
Prenatal Repeat Corticosteroids In Women At Risk Of Preterm Birth For Improving Neonatal Health - An Individual Patient Data Review
Funder
National Health and Medical Research Council
Funding Amount
$461,063.00
Summary
Giving repeat doses of prenatal corticosteroids to women at high risk of preterm birth reduces the risk of their babies having serivous health problems in the early weeks of life. It is unclear what dose, number of doses and interval between doses of corticosteroids is optimal. This review will determine if and how individual women should be treated with repeat corticosteroids to improve the health of their baby born too soon.
Magnesium Sulphate In Women At Risk Of Preterm Birth For Fetal Neuroprotection - An Individual Patient Data Review
Funder
National Health and Medical Research Council
Funding Amount
$276,002.00
Summary
Infants born preterm are at high risk of dying and survivors have a higher risk of neurological problems. Evidence suggests that giving magnesium sulphate to women at risk of preterm birth prior to delivery reduces cerebral palsy in surviving children. It is unclear which women may benefit, what dose and when prior to birth should magnesium sulphate be given. This review will determine how individual women should be treated with magnesium to help protect the brain of a baby born too soon.
Erythropoiesis Stimulating Agents are used to correct the anaemia associated with kidney disease, and cost Australia around $100m in 2004. The optimal target haemoglobin remains the subject of intense debate despite several large trials in the area. This project will use pooled data from these trials to provide a definitive analysis of the overall harms and benefits associated with different targets for the first time and will guide the use of these expensive drugs to maximise patient benefit.
The Blood Pressure Lowering Treatment Trialists' Collaboration
Funder
National Health and Medical Research Council
Funding Amount
$166,250.00
Summary
Treatments that lower blood pressure are well known to reduce the risk of heart attack and stroke, and several different classes of blood pressure lowering drug are now widely used. While all the main classes of drug offer protection against serious complications, it is possible that one drug class may be better than the others. However, whether this is so remains uncertain and cannot be reliably determined by any one single study. The Blood Pressure Lowering Treatment Trialists' Collaboration i ....Treatments that lower blood pressure are well known to reduce the risk of heart attack and stroke, and several different classes of blood pressure lowering drug are now widely used. While all the main classes of drug offer protection against serious complications, it is possible that one drug class may be better than the others. However, whether this is so remains uncertain and cannot be reliably determined by any one single study. The Blood Pressure Lowering Treatment Trialists' Collaboration is a large international project led by a group of Australian researchers based at the Institute for International Health in Sydney. The aim of the project is to systematically gather together sufficient information from large-scale studies to make it possible to answer important outstanding questions about the effects of different classes of blood pressure lowering drugs on major outcomes, such as heart attack and stroke. The Collaboration includes many of the leading blood pressure researchers from around the world and will combine data from more than 30 trials and over 200,000 individuals. On the basis of the overview results it should be possible to provide doctors with important new information about the best blood pressure lowering treatment for their patients. A previous review of the effects of blood pressure drugs completed by the same group was published in The Lancet in 2000, and has been an important aid to many professional and regulatory groups in the year since. Reliable information about the effects of different classes of blood pressure lowering drugs is of great importance. Even if differences between the effects of different classes of drug are small, the implications for the prevention of blood pressure-related complications would be substantial because of the very large numbers of people taking them, worldwide. This collaborative overview project offers a unique opportunity to provide the most reliable and up-to-date information on the subject.Read moreRead less
This study will provide highly reliable information about the use of tight blood glucose control in critically ill patients. It involves an international collaboration between opinion leaders in this field and uses sophisticated statistical methods to combine data from all the clinical trials in this area. The study will clarify many of the current clinical questions about tight glucose control during critical illness, informing practice guidelines in Australia and around the world.
Blood Pressure Lowering In Patients With Chronic Kidney Disease: Evidence From Prospectively Planned Overview Analyses
Funder
National Health and Medical Research Council
Funding Amount
$257,271.00
Summary
This study will provide highly reliable information about the best way of managing blood pressure in people with chronic kidney disease. It will use sophisticated methods to summarize information from 25 large clinical trials and 160,000 participants to determine whether lowering blood pressure reduces the risk of heart disease and further kidney damage.The study will also determine whether currently recommended blood pressure drugs are those which will provide the most benefit.