• Neurocritical care · Feb 2020

    Review Meta Analysis

    Fibrinolytics and Intraventricular Hemorrhage: A Systematic Review and Meta-analysis.

    • Thomas S van Solinge, Ivo S Muskens, Vasileios K Kavouridis, William B Gormley, Rania A Mekary, BroekmanMarike L DMLDComputational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.Department of Neurosurg, and Omar Arnaout.
    • Computational Neurosciences Outcome Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. tsolinge@planet.nl.
    • Neurocrit Care. 2020 Feb 1; 32 (1): 262271262-271.

    AbstractIntraventricular hemorrhage (IVH) is an independent poor prognostic factor in subarachnoid and intra-parenchymal hemorrhage. The use of intraventricular fibrinolytics (IVF) has long been debated, and its exact effects on outcomes are unknown. A systematic review and meta-analysis were performed in accordance with the PRISMA guidelines to assess the impact of IVF after non-traumatic IVH on mortality, functional outcome, intracranial bleeding, ventriculitis, time until clearance of third and fourth ventricles, obstruction of external ventricular drains (EVD), and shunt dependency. Nineteen studies were included in the meta-analysis, totaling 1020 patients. IVF was associated with lower mortality (relative risk [RR] 0.58; 95% confidence interval [CI] 0.47-0.72), fewer EVD obstructions (RR 0.41; 95% CI 0.22-0.74), and a shorter time until clearance of the ventricles (median difference [MD] - 4.05 days; 95% CI - 5.52 to - 2.57). There was no difference in good functional outcome, RR 1.41 (95% CI 0.98-2.03), or shunt dependency, RR 0.93 (95% CI 0.70-1.22). Correction for publication bias predicted an increased risk of intracranial bleeding, RR 1.67 (95% CI 1.01-2.74) and a lower risk of ventriculitis, RR 0.68 (95% CI 0.45-1.03) in IVH patients treated with IVF. IVF was associated with improved survival, faster clearance of blood from the ventricles and fewer drain obstructions, but further research is warranted to elucidate the effects on ventriculitis, long-term functional outcomes, and re-hemorrhage.

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