Intravenous Glycerol Treatment of Acute Stroke – A Statistical Review

Rogvi-Hansen, B; Boysen, Gudrun

doi:10.1159/000108981

Cited by 16 publications

(9 citation statements)

References 10 publications

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“…If we compare this review with the previous one [3], 3 further studies were considered, but still the number of identified trials of glycerol treatment for acute stroke and the total number of patients included were low. The method of randomisation and concealment were adequate in less than half of the trials.…”

Section: Discussionmentioning

confidence: 99%

“…Patients admitted to hospital with acute stroke are also at high risk of dying; the observed one month case fatality rate in trials with placebo treatment varies from 21 to 50 % [3]. Stroke-related oedema is maximal two to four days after stroke onset and is a major cause of early neurological deterioration and death [4].…”

Section: Introductionmentioning

confidence: 99%

“…Glycerol is a hyperosmolar agent that is claimed to reduce infarct-related oedema without rebound effect [5], to increase cerebral blood flow, and to improve cerebral metabolism by recoupling the uncoupled oxidative phosphorylation in the ischaemic brain tissue [6,7]. Side effects of the treatment seem to be negligible [3].…”

Section: Introductionmentioning

confidence: 99%

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Glycerol for acute stroke: a Cochrane systematic review

Righetti¹,

Celani²,

Cantisani

et al. 2002

Journal of Neurology

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Brain oedema is a major cause of early death after stroke. Glycerol is a hyperosmolar agent that is claimed to reduce brain oedema. We sought to determine whether I. V. glycerol treatment in acute stroke, either ischaemic or haemorrhagic, influences death rates and functional outcome in the short or long term and whether the treatment is safe. The Cochrane Stroke Group Trials Register was searched, conference proceedings were screened and some trialists were personally contacted. We considered all completed, controlled, published and unpublished comparisons, evaluating clinical outcome, in which intravenous glycerol treatment was initiated within the first days after stroke onset. Death from all causes, functional outcome and adverse effects were analysed. Analysis of short term death for acute ischaemic and/or haemorrhagic stroke was possible in ten trials where 482 glycerol treated patients were compared with 463 control patients. Glycerol was associated with a non-significant reduction in the odds of death within the scheduled treatment period (OR 0.78, 95 % Confidence Intervals 0.58-1.06). Among patients with definite or probable ischaemic stroke, glycerol was associated with a significant reduction in the odds of death during the scheduled treatment period (odds ratio 0.65, 95 % CI 0.44-0.97). However, at the end of the scheduled follow up period there was no significant difference in the odds of death (odds ratio 0.98, 95 % CI 0.73-1.31). Functional outcome was reported in only two studies and there was a non-significant positive effect on outcome at the end of scheduled follow up (odds ratio 0.73, 95 % CI 0.37-1.42). Haemolysis seems to be the only relevant adverse effect of glycerol treatment. This systematic review suggests a favourable effect of glycerol treatment on short term survival in probable or definite ischaemic stroke, but the magnitude of the treatment effect may be minimal (as low as a 3 % reduction in odds). Because of the relatively small number of patients and because the trials have been performed in the pre-CT era, the results must be interpreted cautiously. The lack of evidence of benefit in long term survival does not support the routine or selective use of glycerol treatment in patients with acute stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Glycerol for acute stroke: a Cochrane systematic review

Righetti¹,

Celani²,

Cantisani

et al. 2002

Journal of Neurology

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“…However, 2 recent systematic reviews have not demonstrated any significant effect on stroke mortality [26,27] although there was a tendency towards improved outcome in the treated group. However, 2 recent systematic reviews have not demonstrated any significant effect on stroke mortality [26,27] although there was a tendency towards improved outcome in the treated group.…”

Section: Glycerolmentioning

confidence: 93%

Acute Cerebral Infarction

Langhorne

Stott²

1995

Drugs & Aging

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The optimal management of acute cerebral infarction requires consideration of the diagnosis, aetiology, identification of problems, general and specific aspects of care, and prevention of further vascular events. Stroke is a clinical diagnosis but cranial computed tomography (CT) scanning is invaluable to exclude the possibility of cerebral haemorrhage or where the diagnosis is uncertain. Good general care under a specialist multidisciplinary team can reduce mortality and the need for institutional care. Despite promising results from experimental studies, no routine drug therapies have yet shown clinical benefit in acute stroke. Several large trials are currently evaluating anticoagulant, antiplatelet, thrombolytic and neuroprotective agents. Many other proposed therapies have been subject to limited evaluation. Aspirin has a proven role in the prevention of further vascular events after a stroke or transient ischaemic attack. Warfarin, and to a lesser extent aspirin, can prevent recurrent events in patients with nonrheumatic atrial fibrillation. Concerns remain about the safety of warfarin in routine geriatric medical practice. The risk of recurrent stroke in patients with a symptomatic severe carotid artery stenosis is greatly reduced by endarterectomy.

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“…Among these are over 200 truly randomised studies whose results have been reviewed recently. [1][2][3][4][5][6][7][8] It is well beyond the resources of a single physician to undertake a systematic review of such a large body of evidence, yet a systematic review is the only means of deriving a useful summary of the evidence. Although the number of trials in other areas of neurology and neurosurgery is perhaps not so daunting, it is safe to assume that most clinical neurologists and neurosurgeons would welcome systematic reviews of all the available evidence from trials, particularly if the review were regularly updated in the light of any new evidence.…”

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confidence: 99%