The incidence of cardiotoxicity events in patients who use 5-fluorouracil (5-FU) and capecitabine monotherapy remains unclear since previous studies reported the prevalence in patients who used combination regimens. We aimed to systematically review and meta-analyze the incidence of cardiotoxicity in fluorouracil and capecitabine monotherapy users. The study protocol was registered with PROSPERO (CRD42023441627). Systematic searches were conducted in five databases (CINAHL, OpenGrey, PubMed, ScienceDirect, and Scopus). The Cochrane Risk-of-Bias tool and the Risk Of Bias In Non-randomized Studies were used to evaluate the risk of bias. Pooled prevalence and 95% confidence interval (CI) were calculated using the DerSimonian-Laird random effect models. The funnel plot was used to assess the publication bias. Eighty studies were included. There were 24 randomized controlled trials (RCTs) with low to high risk of bias and 56 non-RCTs with critical risk of bias. The pooled prevalence of cardiotoxicity from 5-FU was 3.5% (95% CI: 2.7 - 4.2; P < 0.001; I² = 73.86%). The pooled prevalence of cardiotoxicity in capecitabine users was 2.8% (95% CI: 1.6 - 4.0; P < 0.001; I² = 72.62%). The prevalence of cardiotoxicity from 5-FU and capecitabine was classified as common. Cardiotoxicity may have not been associated with the cumulative dose of 5-FU or capecitabine.

The use of levonorgestrel emergency oral contraceptives (EOCs) is one of the factors that may be associated with ectopic pregnancy. We aimed to investigate the incidence of ectopic pregnancy in EOC users and the association between EOCs and ectopic pregnancy. We searched for articles that provided the incidence of and the association between levonorgestrel EOCs and ectopic pregnancy in women of reproductive ages in CINAHL Complete, Medline, OpenDissertations, Scopus, Science Direct, and Thai Journal Online. The risk of bias was assessed by Risk Of Bias In Non-randomized Studies or Risk of Bias 2. A meta-analysis was conducted using the random-effects model. We retrieved 1839 nonredundant articles from the systematic search. The meta-analysis showed that the prevalence of ectopic pregnancy was not statistically different from zero (pooled prevalence estimate = 0.029%; 95%CI: -0.006, 0.065; N = 9; I² = 0) and rare. In addition, levonorgestrel EOCs increased the risk of ectopic pregnancy (OR = 6.17; 95%CI: 3.78, 10.08; N = 5; I² = 43%). Women with extrauterine or ectopic pregnancy had higher odds of using levonorgestrel emergency oral contraceptives than those with intrauterine pregnancy. However, the prevalence of ectopic pregnancy is rare.

Pharmacists’ knowledge and attitude toward Emergency Oral Contraception (EOC) can affect users’ access to EOCs, especially where EOCs are provided by pharmacists without the need for prescriptions. We conducted a Knowledge, Attitudes, and Practice (KAP) survey on Thai pharmacists to better understand KAP related to EOCs and the correlation among KAP components. An in-depth interview, GoogleTrend search, and Pantip.com search were conducted. The findings, together with data from a previously published systematic review and meta-analysis, were used to develop KAP survey questions which were distributed online. Spearman’s rank correlation coefficient and linear mixed model were used to investigate the correlation and association among KAP components. The in-depth interview with pharmacists showed that sex and unwanted pregnancy are very sensitive topics in Thailand. Sex and EOC education should be provided by parents and healthcare professionals at a young age. This agreed with opinions from Thai internet users that sex literacy was generally low and sex education was not provided adequately. From the total of 421 survey responses, Thai pharmacists had average knowledge, poor attitude, and average practice related to EOCs (median score = 51.02%, 21.81%, and 60.0%, respectively). The correlations between KAP in pharmacists were weak (ρ = 0.107–0.525, p < 0.02). Pharmacists who rated themselves as having higher scores in knowledge and attitude also rated themselves higher in the practice score. However, the total scores describing the knowledge of or attitude toward EOCs were not associated with EOC practice scores. In Thai pharmacists, self-rating KAP scores overestimated total KAP scores. The correlation among KAP components was weak. EOC knowledge and attitudes should be promoted, although this may not improve EOC practice in Thai pharmacists.

The Impact of Omitting 5-FU Bolus From mFOLFOX6 Chemotherapy Regimen on Hematological Adverse Events Among Patients With Metastatic Colorectal Cancer

Background: Patients who had mechanical heart valves and an international normalized ratio (INR) of >5.0 should be managed by temporary cessation of vitamin K antagonist. This study aimed to investigate the safety of low-dose vitamin K1 in patients with mechanical heart valves who have supratherapeutic INR. Methods: CINAHL, Cochran Library, Clinical trial.gov, OpenGrey, PubMed, ScienceDirect, and Scopus were systematically searched from the inception up to October 2021 without language restriction. Studies comparing the safety of low-dose vitamin K1 treatment in patients with placebo or other anticoagulant reversal agents were included. We used a random-effect model for the meta-analysis. Publication bias was determined by a funnel plot with subsequent Begg’s test and Egger’s test. Results: From 7529 retrieved studies, 3 randomized control trials were included in the meta-analysis. Pooled data demonstrated that low-dose vitamin K was not associated with thromboembolism rate (risk ratio [RR] = 0.94; 95% CI: 0.19–4.55) major bleeding rate (RR = 0.58; 95% CI: 0.07–4.82), and minor bleeding rate (RR = 0.60; 95% CI: 0.07–5.09). Subgroup and sensitivity analysis demonstrated the nonsignificant effect of low-dose vitamin K on the risk of thromboembolism. Publication bias was not apparent, according to Begg’s test and Egger’s test (P = .090 and 0.134, respectively). Conclusion: The current evidence does not support the role of low-dose vitamin K as a trigger of thromboembolism in supratherapeutic INR patients with mechanical heart valves. Nevertheless, more well-designed studies with larger sample sizes are required to justify this research question.

Background: The optimal apixaban dose for patients with atrial fibrillation (AF) and advanced chronic kidney disease (CKD; CrCl < 30 mL/min) remains uncertain because randomized trials largely excluded this population, and dose-specific evidence is limited. Objectives: This study aimed to compare the efficacy and safety of standard- versus reduced-dose apixaban and to evaluate each regimen against vitamin K antagonists (VKAs). Methods: We conducted a systematic review (SR) and network meta-analysis (NMA) that complied with PRISMA 2020. PubMed, Scopus, ScienceDirect, Cochrane Library, and EBSCO Open Dissertations were searched through 10 January 2026. Randomized trials and cohort studies enrolling adults with AF and CrCl < 30 mL/min were included. Primary outcomes were stroke/systemic embolism (SE) and major bleeding; secondary outcomes were any bleeding and all-cause mortality. A frequentist random-effects NMA was conducted using a consistency model. Treatment effects were estimated as hazard ratios (HRs) with 95% confidence intervals (CIs). Pairwise meta-analyses were also performed for direct comparisons. Results: Nine studies involving 65,976 patients were included. In the NMA, standard-dose apixaban did not significantly differ from reduced-dose apixaban for stroke/SE, major bleeding, or any bleeding, but was associated with lower all-cause mortality (HR 0.73, 95% CI 0.62–0.87). Compared with VKAs, both standard- and reduced-dose apixaban were associated with lower risks of stroke/SE, major bleeding, any bleeding, and all-cause mortality. Conclusions: In AF patients with advanced CKD, both standard- and reduced-dose apixaban were associated with more favorable outcomes than VKAs, although the certainty of evidence was generally low.