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Intraventricular Fibrinolysis Versus External Ventricular Drainage Alone in Intraventricular Hemorrhage: A Meta-Analysis.
MedLine Citation:
PMID:  21817146     Owner:  NLM     Status:  Publisher    
BACKGROUND AND PURPOSE: The purpose of this study was to analyze the effect of intraventricular fibrinolysis (IVF) compared with external ventricular drainage alone on mortality and functional outcome in the management of intraventricular hemorrhage secondary to spontaneous supratentorial intracerebral hemorrhage. METHODS: The authors conducted a systematic review and performed a meta-analysis. They reviewed the PubMed, Cochrane Library, and Liliacs databases. In addition, they conducted a manual review of article bibliographies. RESULTS: Using a prespecified search strategy, 4 randomized and 8 observational studies were included in a meta-analysis. These studies involved a total of 316 patients with intraventricular hemorrhage at baseline, of whom 167 had IVF (52·8%). Pooled odds ratios of the impact of IVF on patient mortality, functional outcomes, and complications were calculated. The overall mortality risk decreased from 46·7% in the external ventricular drainage alone group to 22.7% in the external ventricular drainage+IVF group, corresponding to an overall pooled Peto OR of 0.32 (95% CI, 0.19 to 0.52). This result was highly significant with urokinase, not with recombinant tissue-type plasminogen activator. IVF was also associated with an increase in good functional outcome. There was no difference between the 2 groups in terms of shunt dependence and complications. CONCLUSIONS: The combination of IVF and external ventricular drainage in the management of severe intraventricular hemorrhage secondary to small intracerebral hemorrhage in young patients was associated with better survival and functional outcome results. Urokinase and recombinant tissue-type plasminogen activator could not have the same therapeutic effects. Well-designed randomized trials with special considerations to the fibrinolytic agents are needed.
Thomas Gaberel; Cristian Magheru; Jean-Jacques Parienti; Hagen Bernhard Huttner; Denis Vivien; Evelyne Emery
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-4
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Neurosurgery, Caen University Hospital, Caen, France; INSERM U919, Sérine Protease and Pathophysiology of the Neurovascular Unit, Centre d'Imagerie et de Neurosciences Appliquées aux Pathologies, University Caen Lower Normandy, Caen, France; Unité de Recherche Clinique, Caen University Hospital, Caen, France; and the Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.
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