Article type
Year
Abstract
Introduction/Objective: To determine the effect of antifibrinolytic treatment on clinical outcome, rates of re-bleeding, cerebral ischaemia and hydrocephalus in patients with aneurysmal subarachnoid haemorrhage (SAH).
Methods: This review has drawn on the search strategy developed for the Stroke Group of the Cochrane Collaboration as a whole. Relevant trials were identified in the Specialised Register of Controlled Trials. All truly randomised unconfounded controlled trials were eligible in which, after concealed allocation, antifibrinolytic drugs (orally or intravenously) were compared to control treatment (open studies) or placebo (blind studies) in an intention to treat analysis. Included were trials with patients with clinical symptoms and signs of SAH with confirmation of subarachnoid blood on CT-scan or on cerebrospinal fluid examination.
Results: Eight studies met the predefined inclusion criteria and were finally included. Antifibrinolytic treatment showed neither in the meta-analysis concerning 'poor outcome' (death, vegetative state or severe disability on the Glasgow Outcome Scale) (OR 1.05, 95% CL. 0.76-1.46), nor on case fatality (OR 0.96, 95% CL. 0.72-1.26) an significant effect. Antifibrinolytic therapy reduced, however, significantly the risk of rebleeding (OR 0.59, 95% CL. 0,42-0.81), but increased, also significantly, the risk of cerebral ischaemia (OR 2.03 95% CL. 1.40-2,94) and had no effect on the reported rates of hydrocephalus (OR 1.05, 95% CL, 0.71-1.56).
Discussion: The included trials were all done more than 10 years ago. Since then, strategies have emerged to prevent and treat cerebral ischaemia. Adding these treatment-strategies may abate the ischaemia inducing potential of antifibrinolytic treatmpnt and therefore lead to improved outcome. Since there are no trials which have investigated the effects of the combined antifibrinolytic and anti-ischaemia treatment, the present reviewers are currently undertaking such a trial (STAR-study).
Methods: This review has drawn on the search strategy developed for the Stroke Group of the Cochrane Collaboration as a whole. Relevant trials were identified in the Specialised Register of Controlled Trials. All truly randomised unconfounded controlled trials were eligible in which, after concealed allocation, antifibrinolytic drugs (orally or intravenously) were compared to control treatment (open studies) or placebo (blind studies) in an intention to treat analysis. Included were trials with patients with clinical symptoms and signs of SAH with confirmation of subarachnoid blood on CT-scan or on cerebrospinal fluid examination.
Results: Eight studies met the predefined inclusion criteria and were finally included. Antifibrinolytic treatment showed neither in the meta-analysis concerning 'poor outcome' (death, vegetative state or severe disability on the Glasgow Outcome Scale) (OR 1.05, 95% CL. 0.76-1.46), nor on case fatality (OR 0.96, 95% CL. 0.72-1.26) an significant effect. Antifibrinolytic therapy reduced, however, significantly the risk of rebleeding (OR 0.59, 95% CL. 0,42-0.81), but increased, also significantly, the risk of cerebral ischaemia (OR 2.03 95% CL. 1.40-2,94) and had no effect on the reported rates of hydrocephalus (OR 1.05, 95% CL, 0.71-1.56).
Discussion: The included trials were all done more than 10 years ago. Since then, strategies have emerged to prevent and treat cerebral ischaemia. Adding these treatment-strategies may abate the ischaemia inducing potential of antifibrinolytic treatmpnt and therefore lead to improved outcome. Since there are no trials which have investigated the effects of the combined antifibrinolytic and anti-ischaemia treatment, the present reviewers are currently undertaking such a trial (STAR-study).