Fibrinolytic for treatment of intraventricular hemorrhage: A meta-analysis and systematic review

Abstract

Background Intraventricular hemorrhage is a significant cause of mortality and morbidity worldwide. Treating intraventricular hemorrhage with intraventricular fibrinolytic therapy via a catheter is becoming an increasingly utilized intervention. Aims This meta-analysis aimed to investigate the role of intraventricular fibrinolytic treatment in hypertensive intraventricular hemorrhage patients and evaluate the effect sizes for survival as well as level of function at differing time points. Summary of review PubMed, CNKI, VIP, and Wanfang were searched using the terms "IVH" and "IVH and ICH" for human studies with adult patients published between January 1950 and July 2016. Seventeen publications were selected. Data analysis showed lower rates of mortality in the treatment group at 30 days ( P < 0.001), 180 days ( P = 0.001), 365 days ( P = 0.40), and overall ( P < 0.001). Pooling modified Rankin Scale and Glasgow outcome scale data, the treatment group had more good functional outcomes at 30 days ( P = 0.38), 90 days ( P = 0.04), 180 days ( P = 0.31), 365 days ( P = 0.76), and overall ( P = 0.02). Good functional outcome was defined as modified Rankin Scale score of 0 to 3 or a Glasgow outcome scale score of 3 to 5. Conclusions Intraventricular fibrinolytic for treatment of hypertensive intraventricular hemorrhage reduces mortality and potentially leads to an increased number of good functional outcomes. Different functional outcome scales (modified Rankin Scale or Glasgow outcome scale) produce different effect sizes. Intraventricular fibrinolytic treatment may offer intraventricular hemorrhage patients a targeted therapy that produces meaningful mortality benefit and possible functional outcome benefits.

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

“…However, in a sensitivity analysis, correction for publication bias estimated an increased risk of intracranial bleeding and a lower risk of ventriculitis for patients receiving IVF. Previous systematic reviews have been cautiously optimistic regarding the use of IVF in IVH [16,17,40]. Recently, a systematic review from Wang et al [16] concluded that IVF was associated with lower risk of mortality (RR 0.63, 95% CI 0.47-0.83) and ventriculitis (RR 0.57, 95% CI 0.35-0.93), but did not change the likelihood of poor functional outcome (RR 0.96, 95% CI 0.83-1.11), shunt dependence (RR 1.06, 95% CI 0.75-1.49), or rehemorrhage (RR 0.57, 95% CI 0.35-0.93).…”

“…The American Heart Association/American Stroke Association guidelines conclude that the efficacy and safety of fibrinolytics in IVH are uncertain [15]. Recently, the CLEAR-III study [14] evaluated the effect of IVF for IVH resulting from small IPHs and observed a decreased risk of mortality, which was endorsed by previous meta-analyses [16,17], while no improvement of good functional outcome (GFO) (modified Rankin Score [mRS] equal to or lower than 3) was observed [14]. Previous systematic reviews have reached different conclusions regarding functional outcome, and discussions regarding the safety of (repeated) injections of fibrinolytic agents into fresh hemorrhages are ongoing [16][17][18][19].…”

Terapia Fibrinolítica na Hemorragia Intraventricular: relato de caso e revisão de literatura

“…Podemos dividir a hemorragia intraventricular em dois tipos: primárias e secundárias. Enquanto o primeiro possui uma maior expectativa de sobrevivência com menores taxas de complicações, HIV secundária a hipertensão arterial sistêmica, doença de Moyamoya, má formação arteriovenosa, aneurisma intracerebral, entre outras, são majoritariamente severas com altas taxas de morbimortalidade 2,4 .…”

“…Um trabalho americano comparou a aplicação de 3mg de Alteplase vs placebo, a cada 12h, até a resolução do coágulo, também com bons desfechos 10 . Outros trabalhos e revisões demonstraram doses e formas diferentes de aplicação, todos com resultados semelhantes 1,2,5,6 .…”

“…A hemorragia intracerebral (HIC) é responsável por cerca de 10 a 15% de todos os acidentes vasculares cerebrais (AVC) ao redor do mundo 1 . A presença de hemorragia intraventricular (HIV) secundária está frequentemente associada a este quadro clínico, aumentando as taxas de morbimortalidade e complicações agudas como hidrocefalia e aumento da pressão intracraniana 2 . O manejo terapêutico imediato dessa afecção consiste na colocação de uma derivação ventricular externa (DVE), permitindo a drenagem do líquido cefalorraquidiano (LCR) e do sangue, tratando a hidrocefalia e a hipertensão intracraniana 3 .…”