Local Fibrinolytic Therapy for Intraventricular Hemorrhage: A Meta-Analysis of Randomized Controlled trials.
Local Fibrinolytic Therapy for Intraventricular Hemorrhage: A Meta-Analysis of Randomized Controlled trials.
复制标题
脑室内出血的局部纤溶治疗：随机对照试验的荟萃分析。
DOI：
10.1016/j.wneu.2017.07.135
复制
发表时间：
2017-11
影响因子：
2
通讯作者：
Selim M
中科院分区：
文献类型：
--
作者：
Wang D;Liu J;Norton C;Liu M;Selim M
脑室内纤溶（IVF）治疗脑室内出血（IVH）患者的安全性和有效性尚不清楚。我们的目的是确定这些问题，并根据亚组分析评估rt-PA和尿激酶之间是否存在差异。在IVH患者中比较rt-PA或尿激酶通过脑室外引流（EVD）给药与生理盐水通过EVD或单独放置EVD的随机对照试验（RCT）的荟萃分析。纳入了6项涉及607例IVH患者的RCT; 2项试验研究了尿激酶和4项rt-PA。IVF降低了随访结束时任何原因导致的死亡（RR 0.63，95% CI 0.47至0.83），这主要是由rt-PA驱动的（RR 0.65，95% CI 0.48至0.86）。尿激酶未降低死亡率（RR 0.30，95% CI 0.06 - 1.53）。然而，rt-PA并未降低功能结局不良的存活者比例（RR 1.36，95% CI 1.04 - 1.77）或死亡和功能结局不良的复合终点（RR 0.96，95% CI 0.83 - 1.11）。IVF既没有减少分流管放置的需要（RR 1.06，95% CI 0.75 - 1.49），也没有增加脑室炎（RR 0.57，95% CI 0.35 - 0.93）和再出血（RR 1.65，95% CI 0.79 - 3.45）。虽然在IVH患者中使用IVF通常是安全的，但其益处仅限于降低死亡率，代价是增加了中重度至重度残疾的幸存者数量。亚组分析未提示IVF联合尿激酶优于rt-PA。
The safety and efficacy of intraventricular fibrinolysis (IVF) in intraventricular hemorrhage (IVH) patients are unclear. We aimed to determine these issues and to evaluate whether there are differences between rt-PA and urokinase according to subgroup analyses. Meta-Analysis of randomized controlled trials (RCTs) in IVH patients comparing the administration of rt-PA or urokinase through extraventricular drainage (EVD) with normal saline through EVD or EVD placement alone. Six RCTs involving 607 IVH patients were included; 2 trials investigated urokinase and 4 rt-PA. IVF reduced death from any cause at the end of follow-up (RR 0.63, 95% CI 0.47 to 0.83), which was mostly driven by rt-PA (RR 0.65, 95% CI 0.48 to 0.86). Urokinase did not reduce mortality (RR 0.30, 95% CI 0.06 to 1.53). However, rt-PA did not reduce the proportion of survivors with poor functional outcome (RR 1.36, 95% CI 1.04 to 1.77), or the composite endpoint of death and poor functional outcome (RR 0.96, 95% CI 0.83 to 1.11). IVF neither reduced the need for shunt placement (RR 1.06, 95% CI 0.75 to 1.49) nor increased ventriculitis (RR 0.57, 95% CI 0.35 to 0.93) and rebleeding (RR 1.65, 95% CI 0.79 to 3.45). Although the use of IVF in IVH patients appears generally safe, its benefit is limited to a reduction in mortality at the expense of an increased number of survivors with moderately severe to severe disability. Subgroup analyses do not suggest an advantage of IVF with urokinase over rt-PA.
登录
查看更多内容
影响因子：
8.3
作者：
Naff N;Williams MA;Keyl PM;Tuhrim S;Bullock MR;Mayer SA;Coplin W;Narayan R;Haines S;Cruz-Flores S;Zuccarello M;Brock D;Awad I;Ziai WC;Marmarou A;Rhoney D;McBee N;Lane K;Hanley DF Jr
通讯作者：
Hanley DF Jr
影响因子：
9.3
作者：
LeBlanc RH 3rd;Chen R;Selim MH;Hanafy KA
通讯作者：
Hanafy KA
影响因子：
4.8
作者：
Naff, NJ;Hanley, DF;Schmutzhard, E
通讯作者：
Schmutzhard, E
影响因子：
2.8
作者：
AKDEMIR, H;SELCUKLU, A;KAVUNCU, I
通讯作者：
KAVUNCU, I
影响因子：
2
作者：
King, Nicolas K. K.;Lai, Jin Li;Wang, Ernest
通讯作者：
Wang, Ernest