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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
Stroke and Vascular Neurology ( IF 5.9 ) Pub Date : 2021-06-01 , DOI: 10.1136/svn-2021-000941
Ximing Nie 1, 2 , Jingyi Liu 1, 2 , Dacheng Liu 1, 2 , Qi Zhou 1, 2 , Wanying Duan 1, 2 , Yuehua Pu 1, 2 , Zhonghua Yang 1, 2 , Miao Wen 1, 2 , Haixin Sun 3 , Wenzhi Wang 3 , Shengjun Sun 3, 4 , Hongqiu Gu 1, 2 , Liping Liu 2, 5
Affiliation  

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. Data are available upon reasonable request. Data in this article are available upon reasonable request.

中文翻译:

CT标志物对血肿扩大高风险自发性脑出血患者的止血治疗:随机试验的系统评价和荟萃分析

背景和目的 目前的随机对照试验 (RCT) 显示,止血疗法在预防脑出血 (ICH) 患者血肿扩大和改善预后方面的益处不确定。本荟萃分析旨在系统评估止血剂对 RCT 中 CT 征象预测的高危自发性 ICH 患者出血生长的预防作用。方法 对 2005 年 1 月 1 日至 2021 年 6 月 30 日的 PubMed、EMBASE 和 Cochrane 图书馆进行全面检索。纳入了比较止血剂与安慰剂治疗自发性 ICH 患者高风险出血生长的随机对照试验。主要终点是 24 小时血肿扩大。其他感兴趣的主要终点包括 90 天功能结果和死亡率。结果 荟萃分析包括四项随机对照试验,随机分配了 2666 名伴有高危出血生长的 ICH 患者。与安慰剂相比,止血疗法可将血肿扩大率降低到略微具有统计学意义的水平(OR 0.84;95% CI 0.70 至 1.00;p=0.051)。CT 上出现黑洞征的患者的亚组分析显示,使用止血治疗可显着减少血肿扩大(OR 0.61;95% CI 0.39 至 0.94;p=0.03)。然而,主要分析和亚组分析均表明止血治疗不能降低不良功能结局(改良 Rankin 量表>3)或死亡的发生率。结论 止血治疗在减少由 CT 扫描标志物预测的高危自发性 ICH 患者的早期血肿扩大方面显示出轻微的显着益处。然而,没有观察到功能结果的显着改善或死亡率的降低。可根据合理要求提供数据。本文中的数据可根据合理要求提供。
更新日期:2021-06-29
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