ObjectivesTo analyze prospective incidence and risk factors of urolithiasis after Topiramate (TPM) therapy in epileptic patients. MethodsWe prospectively analyzed the incidence of urolithiasis in 120 patients with epilepsy who diagnosed in the Department of Neurology of the First Hospital Affiliated to Dalian Medical University from March 2004 to March 2013. Then calculated the incidence of urolithiasis, and analyzed the risk factors. ResultsIn the 120 cases we collected, male accounted for 74, female accounted for 46. After treated with TPM, the incidence of urolithiasis was 18.3%. All of urolithiasis were kidney stones. The stones caused by TPM were mostly single and small, most of which would disappear spontaneously after discontinuation of the medication. The incidence of asymptomatic urolithiasis was 3.4 times to that of symptomatic urolithiasis. The development of urolithiasis had no correlation with the dose of TPM and duration. Urolithiasis frequently occurred in epilepsy patients in the age over 20 or symptomatic epilepsy or duration of combined medication≥3 months. ConclusionsThe incidence of urolithiasis in epilepsy patients was 18.3% after initiating TPM therapy. The stones would disappear spontaneously after discontinuation of the medication. The development of urolithiasis had no correlation with the dose of topiramate and duration.
ObjectiveTo systematically review therapy-related complications incidences of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement, and to explore the suitable anticoagulation intensity of warfarin. MethodsWe electronically searched The Cochrane Library (Issue 2, 2013), EMbase, PubMed, CNKI, CBM, WanFang Data and VIP for studies about therapy-related complications rates of warfarin with different anticoagulation intensity in Chinese after mechanical heart valve replacement from inception to March 2013. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 7 studies involving 3 787 cases were finally included, 2 985 cases in Group A (targeted INR≤2.3) and 802 cases in Group B (targeted INR > 2.3). The results of meta-analysis showed that, compared with Group B, the total therapy-related complications incidence of warfarin with different anticoagulation intensity significantly decreased in Group A (OR=0.35, 95%CI 0.28 to 0.44, P < 0.000 01). The incidence of hemorrhage in Group A (OR=0.15, 95%CI 0.08 to 0.27, P < 0.000 01) was lower than that in Group B. However, the incidence of embolism in Group A was higher than that in Group B (OR=2.77, 95%CI 1.54 to 4.98, P=0.000 7). ConclusionApplying low-intensity anticoagulation for Chinese patients after mechanical heart valve replacement could reduce the overall incidences of anticoagulation-related complications and hemorrhage, but it could also significantly increase the incidence of thrombosis.