Cochrane · systematic review · CD006544
Prostanoids for critical limb ischaemia
Vietto, V, Franco, JVA, Saenz, V, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
42
current version
GRADE rated
26
No studies
14
Included studies
NR
No studies 14 · 33.3%Ungraded 2 · 4.8%Very low 4 · 9.5%Low 16 · 38.1%Moderate 5 · 11.9%High 1 · 2.4%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyProstanoids compared with placebo for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality Prostanoids vs placebo | RR 0.81 [0.41, 1.58] | 3 studies · 1170 participants | Low Downgraded: risk of bias, imprecision |
Total amputations Prostanoids vs placebo | RR 0.97 [0.86, 1.09] | 12 studies · 2825 participants | High |
Quality of life Prostanoids vs placebo | no estimate extracted | NR | No studies |
Adverse events (participants) Prostanoids vs placebo | RR 2.11 [1.79, 2.5] | 8 studies · 655 participants | Moderate Downgraded: risk of bias |
Rest‐pain relief (dichotomous) Prostanoids vs placebo | RR 1.3 [1.06, 1.59] | 10 studies · 1179 participants | Moderate Downgraded: risk of bias |
Ulcer healing Prostanoids vs placebo | RR 1.24 [1.04, 1.48] | 11 studies · 1719 participants | Moderate Downgraded: risk of bias |
Prostanoids compared with pentoxifylline for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality Prostanoids vs pentoxifylline | no estimate extracted | NR | No studies |
Total amputations Prostanoids vs pentoxifylline | RR 0.5 [0.05, 5.27] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Prostanoids vs pentoxifylline | no estimate extracted | NR | No studies |
Adverse events (participants) Prostanoids vs pentoxifylline | RR 0.6 [0.24, 1.47] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Rest‐pain relief Prostanoids vs pentoxifylline | RR 1.4 [0.72, 2.72] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Ulcer healing Prostanoids vs pentoxifylline | RR 1.61 [1.13, 2.3] | 1 study · 70 participants | Very low Downgraded: risk of bias, imprecision |
Prostanoids compared with naftidrofuryl for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality Prostanoids vs naftidrofuryl | no estimate extracted | NR | No studies |
Total amputations Prostanoids vs naftidrofuryl | RR 0.96 [0.57, 1.64] | 1 study · 29 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Prostanoids vs naftidrofuryl | no estimate extracted | NR | No studies |
Adverse events (participants) Prostanoids vs naftidrofuryl | RR 3.29 [0.27, 40.19] | 2 studies · 55 participants | Low Downgraded: risk of bias, imprecision |
Rest‐pain relief Prostanoids vs naftidrofuryl | RR 1.07 [0.83, 1.39] | 3 studies · 75 participants | Low Downgraded: risk of bias, imprecision |
Ulcer healing Prostanoids vs naftidrofuryl | RR 0.97 [0.46, 2.03] | 2 studies · 39 participants | Low Downgraded: risk of bias, imprecision |
PGE1 compared with ATP for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality PGE1 vs ATP | no estimate extracted | NR | No studies |
Total amputations PGE1 vs ATP | RR 0.26 [0.09, 0.74] | 2 studies · 91 participants | Low Downgraded: risk of bias, imprecision |
Quality of life PGE1 vs ATP | no estimate extracted | NR | No studies |
Adverse event (participants) PGE1 vs ATP | RR 2.78 [1.41, 5.48] | 2 studies · 91 participants | Low Downgraded: risk of bias, imprecision |
Rest‐pain relief PGE1 vs ATP | no estimate extracted | 1 study · 34 participants | Ungraded |
Ulcer healing (complete) PGE1 vs ATP | RR 0.72 [0.17, 3.03] | 1 study · 31 participants | Low Downgraded: risk of bias, imprecision |
PGE1 compared with inositol niacinate for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality PGE1 vs inositol niacinate | no estimate extracted | NR | No studies |
Total amputations PGE1 vs inositol niacinate | no estimate extracted | NR | No studies |
Quality of life PGE1 vs inositol niacinate | no estimate extracted | NR | No studies |
Adverse events (participants) PGE1 vs inositol niacinate | RR 1.6 [0.79, 3.23] | 1 study · 65 participants | Low Downgraded: risk of bias, imprecision |
Rest‐pain relief PGE1 vs inositol niacinate | RR 1.45 [0.88, 2.37] | 1 study · 65 participants | Low Downgraded: risk of bias, imprecision |
Ulcer healing PGE1 vs inositol niacinate | RR 3.06 [0.41, 22.79] | 1 study · 65 participants | Low Downgraded: risk of bias, imprecision |
Iloprost compared with PGE1 for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality Iloprost vs PGE1 | no estimate extracted | NR | No studies |
Total amputations Iloprost vs PGE1 | RR 0.89 [0.66, 1.21] | 1 study · 209 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Iloprost vs PGE1 | no estimate extracted | NR | No studies |
Adverse events (participants) Iloprost vs PGE1 | RR 2.35 [1.82, 3.04] | 4 studies · 511 participants | Moderate Downgraded: risk of bias |
Rest‐pain relief Iloprost vs PGE1 | RR 1.15 [0.9, 1.47] | 1 study · 228 participants | Low Downgraded: risk of bias, imprecision |
Ulcer healing Iloprost vs PGE1 | RR 1.24 [0.95, 1.63] | 1 study · 228 participants | Low Downgraded: risk of bias, imprecision |
Clinprost compared with lipo‐PGE1 for critical limb ischaemia
Population: people with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cardiovascular mortality Clinprost vs lipo‐PGE1 | no estimate extracted | 1 study · 1 participants | Ungraded |
Total amputations Clinprost vs lipo‐PGE1 | no estimate extracted | NR | No studies |
Quality of life Clinprost vs lipo‐PGE1 | no estimate extracted | NR | No studies |
Adverse events Clinprost vs lipo‐PGE1 | RR 1.83 [0.56, 5.96] | 1 study · 135 participants | Moderate Downgraded: imprecision |
Rest‐pain relief Clinprost vs lipo‐PGE1 | RR 1.05 [0.58, 1.87] | 1 study · 67 participants | Low Downgraded: risk of bias, imprecision |
Ulcer healing Clinprost vs lipo‐PGE1 | RR 1.18 [0.74, 1.89] | 1 study · 72 participants | Low Downgraded: risk of bias, imprecision |
Prostanoids compared with placebo for critical limb ischaemia
Population: patients with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rest pain relief Questionnaires Prostanoids vs placebo | RR 1.32 [1.1, 1.57] | 9 studies · 1116 participants | Low |
Ulcer healing size of ulcer / granulation tissue at the base Prostanoids vs placebo | RR 1.54 [1.22, 1.96] | 8 studies · 1132 participants | Very low Downgraded: inconsistency |
Amputations (not defined if majors or totals) number of amputations5 Prostanoids vs placebo | RR 0.89 [0.76, 1.04] | 9 studies · 1790 participants | Low |
Mortality Prostanoids vs placebo | RR 1.07 [0.65, 1.75] | 5 studies · 1391 participants | Very low Downgraded: inconsistency |
Adverse events (patients) Prostanoids vs placebo | RR 2.35 [1.99, 2.78] | 8 studies · 716 participants | Low |
PGE1 compared with placebo for critical limb ischaemia
Population: patients with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rest pain relief Questionnaires PGE1 vs placebo | RR 1.52 [0.69, 3.34] | 2 studies · 69 participants | Very low |
Reduction in analgesics consumption Questionnaires PGE1 vs placebo | RR 1.58 [0.92, 2.72] | 2 studies · 58 participants | Very low |
Adverse events (patients) PGE1 vs placebo | RR 5.81 [1.62, 20.86] | 2 studies · 69 participants | Very low |
Iloprost compared with placebo for critical limb ischaemia
Population: patients with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rest pain relief Questionnaires Iloprost vs placebo | RR 1.54 [1.19, 1.99] | 3 studies · 318 participants | Low |
Ulcer healing size of ulcer / granulation tissue at the base Iloprost vs placebo | RR 1.8 [1.29, 2.5] | 3 studies · 367 participants | Very low Downgraded: inconsistency |
Total Amputations Iloprost vs placebo | RR 0.79 [0.6, 1.03] | 3 studies · 318 participants | Low |
Major amputations Iloprost vs placebo | RR 0.69 [0.52, 0.93] | 3 studies · 318 participants | Low |
Adverse events (patients) Iloprost vs placebo | RR 2.05 [1.68, 2.49] | 3 studies · 378 participants | Low |
Oral iloprost (high and low dose) versus placebo for critical limb ischaemia
Population: patients with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rest pain relief (high and low dose) ‐ Low dose iloprost (50‐100 micro gr bid) Questionnaires Oral iloprost (high and low dose) vs placebo | RR 1.12 [0.73, 1.74] | 2 studies · 224 participants | Low |
Rest pain relief (high and low dose) ‐ High dose iloprost (150 ‐ 200 micro gr bid) Questionnaires Oral iloprost (high and low dose) vs placebo | RR 1.48 [0.99, 2.21] | 2 studies · 223 participants | Low |
Major Amputations (high and low dose) ‐ Low dose iloprost (50‐100 micro gr bid) Oral iloprost (high and low dose) vs placebo | RR 0.86 [0.65, 1.12] | 2 studies · 537 participants | Low |
Major Amputations (high and low dose) ‐ High dose iloprost (150 ‐ 200 micro gr bid) Oral iloprost (high and low dose) vs placebo | RR 0.84 [0.64, 1.11] | 2 studies · 534 participants | Low |
Mortality (high and low dose) ‐ Low dose iloprost (50‐100 micro gr bid) Oral iloprost (high and low dose) vs placebo | RR 0.84 [0.54, 1.32] | 2 studies · 537 participants | Low |
Mortality (high and low dose) ‐ High dose iloprost (150 ‐ 200 micro gr bid) Oral iloprost (high and low dose) vs placebo | RR 0.9 [0.39, 2.09] | 2 studies · 534 participants | Low |
PGE1 compared with ATP for critical limb ischaemia
Population: patients with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Total Amputations PGE1 vs ATP | RR 0.26 [0.09, 0.74] | 2 studies · 91 participants | Low |
Adverse event (patients) PGE1 vs ATP | RR 2.78 [1.41, 5.48] | 2 studies · 91 participants | Low |
Prostanoids compared with placebo (highest quality studies) for critical limb ischaemia
Population: patients with critical limb ischaemia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rest pain relief Questionnaires Prostanoids vs placebo (highest quality studies) | RR 1.45 [1.15, 1.82] | 5 studies · 559 participants | Low |
Ulcer healing size of ulcer / granulation tissue at the base Prostanoids vs placebo (highest quality studies) | RR 1.35 [1.15, 1.58] | 5 studies · 843 participants | Low |
Amputations Prostanoids vs placebo (highest quality studies) | RR 0.91 [0.76, 1.09] | 6 studies · 1546 participants | Low |
Mortality Prostanoids vs placebo (highest quality studies) | RR 1.14 [0.7, 1.85] | 4 studies · 1363 participants | Very low Downgraded: inconsistency |
Adverse events (patients) Prostanoids vs placebo (highest quality studies) | RR 2.38 [1.91, 2.96] | 5 studies · 457 participants | Low |