Postthrombolysis intracranial hemorrhage risk of cerebral microbleeds in acute stroke patients: a systematic review and meta-analysis.
Postthrombolysis intracranial hemorrhage risk of cerebral microbleeds in acute stroke patients: a systematic review and meta-analysis.
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DOI：
10.1111/j.1747-4949.2012.00869.x
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发表时间：
2013-07
期刊：
影响因子：
--
通讯作者：
Benavente OR
中科院分区：
文献类型：
--
作者：
Shoamanesh A;Kwok CS;Lim PA;Benavente OR
在急性缺血性卒中的溶栓治疗中，脑微出血患者发生症状性脑出血的风险是否更大，这一点一直受到质疑。到目前为止，观察性研究尚未显示统计学显著性风险增加;然而，这些研究受到样本量小的限制。目的是更好地量化急性缺血性卒中和磁共振成像脑微出血患者溶栓后脑出血的风险。对研究磁共振成像上微出血的存在作为急性卒中患者溶栓后脑出血的危险因素的对照研究进行了系统评价。进行随机效应模型荟萃分析。在5项研究共790名参与者的汇总分析中，微出血的患病率为17%。微出血的存在显示了溶栓后症状性脑出血风险增加的趋势[比值比：1.98（95%可信区间，0.90 ~ 4.35; P = 0.09），I2 = 0%]。校正分析最小化潜在偏倚导致脑微出血患者发生症状性脑出血的绝对风险增加4.6%[比值比：2.29（95%置信区间，1.01至5.17），I2 = 0%]，达到临界显著性（P = 0.05）。观察到微出血负荷增加与症状性脑出血之间存在显著相关性（P = 0.0015）。对仅使用静脉注射组织型纤溶酶原激活剂的研究进行的孤立分析不显著。我们的数据表明，有脑微出血的患者在急性缺血性卒中溶栓治疗后发生症状性脑出血的风险增加。然而，目前的数据还不足以证明仅仅根据脑微出血的存在而停止对急性缺血性卒中患者进行溶栓治疗的合理性。
It has been questioned whether patients with cerebral microbleeds are at a greater risk for the development of symptomatic intracerebral hemorrhage following thrombolytic therapy in the management of acute ischemic stroke. Thus far, observational studies have not shown a statistically significant increased risk; however, these have been limited by small sample size. The aim is to better quantify the risk of postthrombolysis intracerebral hemorrhage in patients with acute ischemic stroke and cerebral microbleeds on magnetic resonance imaging. A systematic review of controlled studies investigating the presence of microbleeds on magnetic resonance imaging as a risk factor for intracerebral hemorrhage following thrombolysis in acute stroke patients was conducted. A random effects model meta-analysis was performed. In pooled analysis of five studies totaling 790 participants, the prevalence of microbleeds was 17%. The presence of microbleeds revealed a trend toward an increased risk of postthrombolysis symptomatic intracerebral hemorrhage [odds ratio: 1·98 (95% confidence interval, 0·90 to 4·35; P = 0·09), I2 = 0%]. Adjusted analysis minimizing potential bias resulted in an increased absolute risk of 4·6% for the development of symptomatic intracerebral hemorrhage in patients with cerebral microbleeds [odds ratio: 2·29 (95% confidence interval, 1·01 to 5·17), I2 = 0%] reaching borderline significance (P = 0·05). A significant relationship between increasing microbleed burden and symptomatic intracerebral hemorrhage (P = 0·0015) was observed. Isolated analysis of studies using exclusively intravenous tissue plasminogen activator was insignificant. Our data suggest that patients with cerebral microbleeds are at increased risk for symptomatic intracerebral hemorrhage following thrombolysis for acute ischemic stroke. However, current data are insufficient to justify withholding thrombolytic therapy from acute ischemic stroke patients solely of the basis of cerebral microbleed presence.
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影响因子：
3.7
作者：
Moher D;Shamseer L;Clarke M;Ghersi D;Liberati A;Petticrew M;Shekelle P;Stewart LA;PRISMA-P Group
通讯作者：
PRISMA-P Group
影响因子：
7.7
作者：
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通讯作者：
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9.9
作者：
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通讯作者：
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影响因子：
9.9
作者：
Hsia, AW;Sachdev, HS;Tong, DC
通讯作者：
Tong, DC
影响因子：
9.9
作者：
Knudsen, KA;Rosand, J;Greenberg, SM
通讯作者：
Greenberg, SM