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Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials

BACKGROUND AND PURPOSE: Current randomised controlled trials (RCTs) showed an uncertain benefit of haemostatic therapy on preventing haematoma expansion and improving the outcome in patients with intracerebral haemorrhage (ICH). This meta-analysis aims to systematically evaluate the effect of haemos...

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Autores principales: Nie, Ximing, Liu, Jingyi, Liu, Dacheng, Zhou, Qi, Duan, Wanying, Pu, Yuehua, Yang, Zhonghua, Wen, Miao, Sun, Haixin, Wang, Wenzhi, Sun, Shengjun, Gu, Hongqiu, Liu, Liping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258086/
https://www.ncbi.nlm.nih.gov/pubmed/33795489
http://dx.doi.org/10.1136/svn-2021-000941
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author Nie, Ximing
Liu, Jingyi
Liu, Dacheng
Zhou, Qi
Duan, Wanying
Pu, Yuehua
Yang, Zhonghua
Wen, Miao
Sun, Haixin
Wang, Wenzhi
Sun, Shengjun
Gu, Hongqiu
Liu, Liping
author_facet Nie, Ximing
Liu, Jingyi
Liu, Dacheng
Zhou, Qi
Duan, Wanying
Pu, Yuehua
Yang, Zhonghua
Wen, Miao
Sun, Haixin
Wang, Wenzhi
Sun, Shengjun
Gu, Hongqiu
Liu, Liping
author_sort Nie, Ximing
collection PubMed
description BACKGROUND AND PURPOSE: Current randomised controlled trials (RCTs) showed an uncertain benefit of haemostatic therapy on preventing haematoma expansion and improving the outcome in patients with intracerebral haemorrhage (ICH). This meta-analysis aims to systematically evaluate the effect of haemostatic agents on the prevention of haemorrhage growth in patients with high-risk spontaneous ICH predicted by CT signs in RCTs. METHODS: A comprehensive search of PubMed, EMBASE and Cochrane library from 1 January 2005 to 30 June 2021 was conducted. RCTs that compared haemostatic agents with placebo for the treatment of spontaneous patients with ICH with high-risk haemorrhage growth were included. The primary endpoint was haematoma expansion at 24 hours. Other major endpoints of interest included 90-day functional outcome and mortality. RESULTS: The meta-analysis included four RCTs that randomised 2666 patients with ICH with high-risk haemorrhage growth. Haemostatic therapy reduced the rate of haematoma expansion at a marginally statistically significant level when compared with placebo (OR 0.84; 95% CI 0.70 to 1.00; p=0.051). Subgroup analysis for patients with black hole sign on CT revealed a significant reduction of haematoma expansion with haemostatic therapy (OR 0.61; 95% CI 0.39 to 0.94; p=0.03). However, both the primary analysis and subgroup analyses showed that haemostatic therapy could not reduce the rate of poor functional outcome (modified Rankin Scale >3) or death. CONCLUSIONS: Haemostatic therapy showed a marginally significant benefit in reducing early haematoma expansion in patients with high-risk spontaneous ICH predicted by markers on CT scan. However, no significant improvement in functional outcome or reduction of mortality was observed.
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spelling pubmed-82580862021-07-16 Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials Nie, Ximing Liu, Jingyi Liu, Dacheng Zhou, Qi Duan, Wanying Pu, Yuehua Yang, Zhonghua Wen, Miao Sun, Haixin Wang, Wenzhi Sun, Shengjun Gu, Hongqiu Liu, Liping Stroke Vasc Neurol Original Research BACKGROUND AND PURPOSE: Current randomised controlled trials (RCTs) showed an uncertain benefit of haemostatic therapy on preventing haematoma expansion and improving the outcome in patients with intracerebral haemorrhage (ICH). This meta-analysis aims to systematically evaluate the effect of haemostatic agents on the prevention of haemorrhage growth in patients with high-risk spontaneous ICH predicted by CT signs in RCTs. METHODS: A comprehensive search of PubMed, EMBASE and Cochrane library from 1 January 2005 to 30 June 2021 was conducted. RCTs that compared haemostatic agents with placebo for the treatment of spontaneous patients with ICH with high-risk haemorrhage growth were included. The primary endpoint was haematoma expansion at 24 hours. Other major endpoints of interest included 90-day functional outcome and mortality. RESULTS: The meta-analysis included four RCTs that randomised 2666 patients with ICH with high-risk haemorrhage growth. Haemostatic therapy reduced the rate of haematoma expansion at a marginally statistically significant level when compared with placebo (OR 0.84; 95% CI 0.70 to 1.00; p=0.051). Subgroup analysis for patients with black hole sign on CT revealed a significant reduction of haematoma expansion with haemostatic therapy (OR 0.61; 95% CI 0.39 to 0.94; p=0.03). However, both the primary analysis and subgroup analyses showed that haemostatic therapy could not reduce the rate of poor functional outcome (modified Rankin Scale >3) or death. CONCLUSIONS: Haemostatic therapy showed a marginally significant benefit in reducing early haematoma expansion in patients with high-risk spontaneous ICH predicted by markers on CT scan. However, no significant improvement in functional outcome or reduction of mortality was observed. BMJ Publishing Group 2021-04-01 /pmc/articles/PMC8258086/ /pubmed/33795489 http://dx.doi.org/10.1136/svn-2021-000941 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Nie, Ximing
Liu, Jingyi
Liu, Dacheng
Zhou, Qi
Duan, Wanying
Pu, Yuehua
Yang, Zhonghua
Wen, Miao
Sun, Haixin
Wang, Wenzhi
Sun, Shengjun
Gu, Hongqiu
Liu, Liping
Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
title Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
title_full Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
title_fullStr Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
title_full_unstemmed Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
title_short Haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by CT marker: a systematic review and meta-analysis of randomised trials
title_sort haemostatic therapy in spontaneous intracerebral haemorrhage patients with high-risk of haematoma expansion by ct marker: a systematic review and meta-analysis of randomised trials
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258086/
https://www.ncbi.nlm.nih.gov/pubmed/33795489
http://dx.doi.org/10.1136/svn-2021-000941
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