Scolaris Content Display Scolaris Content Display

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

'Risk of bias' summary: review authors' judgements about each risk of bias criteria for each included study
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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias criteria for each included study

Risk of bias graph: review authors' judgements about each risk of bias criteria presented as percentages across all included studies
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias criteria presented as percentages across all included studies

Funnel plot of comparison: 1 Blood clotting factors vs placebo or open control, outcome: 1.1 Death or dependence (mRS 4 to 6) at day 90
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Figure 4

Funnel plot of comparison: 1 Blood clotting factors vs placebo or open control, outcome: 1.1 Death or dependence (mRS 4 to 6) at day 90

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 1 Death or dependence (mRS 4 to 6) at day 90.
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Analysis 1.1

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 1 Death or dependence (mRS 4 to 6) at day 90.

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 2 Death or dependence (GOS‐E 1 to 4) at day 90.
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Analysis 1.2

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 2 Death or dependence (GOS‐E 1 to 4) at day 90.

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 3 Death by day 90.
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Analysis 1.3

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 3 Death by day 90.

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 4 All serious adverse events.
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Analysis 1.4

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 4 All serious adverse events.

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 5 Thromboembolic serious adverse events.
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Analysis 1.5

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 5 Thromboembolic serious adverse events.

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 6 Intracerebral haemorrhage growth by 24 hours.
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Analysis 1.6

Comparison 1 Blood clotting factors vs placebo or open control, Outcome 6 Intracerebral haemorrhage growth by 24 hours.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 1 Death or dependence (mRS 4 to 6) at day 90.
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Analysis 2.1

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 1 Death or dependence (mRS 4 to 6) at day 90.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 2 Death by day 90.
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Analysis 2.2

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 2 Death by day 90.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 3 All serious adverse events.
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Analysis 2.3

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 3 All serious adverse events.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 4 Thromboembolic serious adverse events.
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Analysis 2.4

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 4 Thromboembolic serious adverse events.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 5 Barthel Index.
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Analysis 2.5

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 5 Barthel Index.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 6 EuroQoL health utility score.
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Analysis 2.6

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 6 EuroQoL health utility score.

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 7 Intracerebral haemorrhage growth by 24 hours.
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Analysis 2.7

Comparison 2 Antifibrinolytic drugs vs placebo or open control, Outcome 7 Intracerebral haemorrhage growth by 24 hours.

Comparison 3 Platelet transfusion vs open control, Outcome 1 Death or dependence (mRS 4 to 6) at day 90.
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Analysis 3.1

Comparison 3 Platelet transfusion vs open control, Outcome 1 Death or dependence (mRS 4 to 6) at day 90.

Comparison 3 Platelet transfusion vs open control, Outcome 2 Death by day 90.
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Analysis 3.2

Comparison 3 Platelet transfusion vs open control, Outcome 2 Death by day 90.

Comparison 3 Platelet transfusion vs open control, Outcome 3 All serious adverse events.
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Analysis 3.3

Comparison 3 Platelet transfusion vs open control, Outcome 3 All serious adverse events.

Comparison 3 Platelet transfusion vs open control, Outcome 4 Thromboembolic serious adverse events.
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Analysis 3.4

Comparison 3 Platelet transfusion vs open control, Outcome 4 Thromboembolic serious adverse events.

Comparison 3 Platelet transfusion vs open control, Outcome 5 Intracerebral haemorrhage growth by 24 hours.
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Analysis 3.5

Comparison 3 Platelet transfusion vs open control, Outcome 5 Intracerebral haemorrhage growth by 24 hours.

Comparison 4 Blood clotting factors vs fresh frozen plasma, Outcome 1 Death by day 90.
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Analysis 4.1

Comparison 4 Blood clotting factors vs fresh frozen plasma, Outcome 1 Death by day 90.

Comparison 4 Blood clotting factors vs fresh frozen plasma, Outcome 2 All serious adverse events.
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Analysis 4.2

Comparison 4 Blood clotting factors vs fresh frozen plasma, Outcome 2 All serious adverse events.

Summary of findings for the main comparison. Blood clotting factors versus placebo or open control

Blood clotting factors compared with placebo or open control for acute spontaneous intracerebral haemorrhage

Patient or population: adults with acute spontaneous intracerebral haemorrhage

Settings: secondary care

Intervention: recombinant activated factor VII

Comparison: placebo or open control

Outcomes

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Death or dependence (mRS 4 to 6) at day 90

RR 0.87 (0.70 to 1.07)

1390
(6)

⊕⊕⊕⊝
moderate¹

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; RR: risk ratio; mRS: modified Rankin Scale

¹We downgraded the quality of the evidence once because of imprecision.

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Summary of findings for the main comparison. Blood clotting factors versus placebo or open control
Summary of findings 2. Antifibrinolytic drugs versus placebo

Antifibrinolytic drugs compared with placebo for acute spontaneous intracerebral haemorrhage

Patient or population: adults with acute spontaneous intracerebral haemorrhage

Settings: secondary care

Intervention: tranexamic acid

Comparison: placebo

Outcomes

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Death or dependence (mRS 4 to 6) at day 90

RR 1.25 (0.57 to 2.75)

24
(1)

⊕⊕⊕⊝
moderate¹

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; RR: risk ratio; mRS: modified Rankin Scale

¹We downgraded the quality of the evidence once because of imprecision.

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Summary of findings 2. Antifibrinolytic drugs versus placebo
Summary of findings 3. Platelet transfusion versus open control

Platelet transfusion compared with open control for acute spontaneous intracerebral haemorrhage associated with antiplatelet drug use

Patient or population: adults with acute spontaneous intracerebral haemorrhage associated with antiplatelet drug use

Settings: secondary care

Intervention: platelet transfusion

Comparison: open control

Outcomes

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Death or dependence (mRS 4 to 6) at day 90

RR 1.29 (1.04 to 1.61)

190
(1)

⊕⊕⊕⊝
moderate¹

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval; RR: risk ratio; mRS: modified Rankin Scale

¹We downgraded the quality of the evidence once because of imprecision.

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Summary of findings 3. Platelet transfusion versus open control
Summary of findings 4. Blood clotting factors versus fresh frozen plasma

Blood clotting factors compared with fresh frozen plasma for acute spontaneous intracerebral haemorrhage associated with anticoagulant drug use

Patient or population: adults with acute spontaneous intracerebral haemorrhage associated with anticoagulant drug use

Settings: secondary care

Intervention: fresh frozen plasma (intravenous), vitamin K (subcutaneous), and factor IX complex concentrate

Comparison: fresh frozen plasma (intravenous)

Outcomes

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Death or dependence (mRS 4 to 6) at day 90

No evidence

No evidence as mRS not measured

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

CI: confidence interval

Figures and Tables -
Summary of findings 4. Blood clotting factors versus fresh frozen plasma
Comparison 1. Blood clotting factors vs placebo or open control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependence (mRS 4 to 6) at day 90 Show forest plot

6

1390

Risk Ratio (IV, Random, 95% CI)

0.87 [0.70, 1.07]

1.1 Acute spontaneous ICH

5

1369

Risk Ratio (IV, Random, 95% CI)

0.86 [0.66, 1.11]

1.2 Acute spontaneous ICH undergoing craniotomy

1

21

Risk Ratio (IV, Random, 95% CI)

0.88 [0.59, 1.31]

2 Death or dependence (GOS‐E 1 to 4) at day 90 Show forest plot

3

486

Risk Ratio (IV, Random, 95% CI)

0.90 [0.81, 1.01]

2.1 Acute spontaneous ICH

3

486

Risk Ratio (IV, Random, 95% CI)

0.90 [0.81, 1.01]

3 Death by day 90 Show forest plot

7

1480

Risk Ratio (IV, Random, 95% CI)

0.75 [0.51, 1.09]

3.1 Acute spontaneous ICH

6

1459

Risk Ratio (IV, Random, 95% CI)

0.71 [0.44, 1.14]

3.2 Acute spontaneous ICH undergoing craniotomy

1

21

Risk Ratio (IV, Random, 95% CI)

0.86 [0.41, 1.80]

4 All serious adverse events Show forest plot

2

87

Risk Ratio (IV, Random, 95% CI)

0.81 [0.30, 2.22]

4.1 Acute spontaneous ICH

2

87

Risk Ratio (IV, Random, 95% CI)

0.81 [0.30, 2.22]

5 Thromboembolic serious adverse events Show forest plot

5

1398

Risk Ratio (IV, Random, 95% CI)

1.24 [0.80, 1.91]

5.1 Acute spontaneous ICH

5

1398

Risk Ratio (IV, Random, 95% CI)

1.24 [0.80, 1.91]

6 Intracerebral haemorrhage growth by 24 hours Show forest plot

3

151

Risk Ratio (IV, Random, 95% CI)

0.74 [0.36, 1.48]

6.1 Acute spontaneous ICH

3

151

Risk Ratio (IV, Random, 95% CI)

0.74 [0.36, 1.48]

Figures and Tables -
Comparison 1. Blood clotting factors vs placebo or open control
Comparison 2. Antifibrinolytic drugs vs placebo or open control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependence (mRS 4 to 6) at day 90 Show forest plot

1

24

Risk Ratio (IV, Random, 95% CI)

1.25 [0.57, 2.75]

1.1 Acute spontaneous ICH

1

24

Risk Ratio (IV, Random, 95% CI)

1.25 [0.57, 2.75]

2 Death by day 90 Show forest plot

3

57

Risk Ratio (IV, Random, 95% CI)

1.16 [0.31, 4.39]

2.1 Acute spontaneous ICH

3

57

Risk Ratio (IV, Random, 95% CI)

1.16 [0.31, 4.39]

3 All serious adverse events Show forest plot

1

24

Risk Ratio (IV, Random, 95% CI)

1.5 [0.39, 5.83]

3.1 Acute spontaneous ICH

1

24

Risk Ratio (IV, Random, 95% CI)

1.5 [0.39, 5.83]

4 Thromboembolic serious adverse events Show forest plot

1

24

Risk Ratio (IV, Random, 95% CI)

1.59 [0.07, 35.15]

4.1 Acute spontaneous ICH

1

24

Risk Ratio (IV, Random, 95% CI)

1.59 [0.07, 35.15]

5 Barthel Index Show forest plot

1

24

Mean Difference (IV, Random, 95% CI)

‐22.50 [‐45.65, 0.65]

5.1 Acute spontaneous ICH

1

24

Mean Difference (IV, Random, 95% CI)

‐22.50 [‐45.65, 0.65]

6 EuroQoL health utility score Show forest plot

1

24

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.35, 0.27]

6.1 Acute spontaneous ICH

1

24

Mean Difference (IV, Random, 95% CI)

‐0.04 [‐0.35, 0.27]

7 Intracerebral haemorrhage growth by 24 hours Show forest plot

3

57

Risk Ratio (IV, Random, 95% CI)

0.76 [0.56, 1.05]

7.1 Acute spontaneous ICH

3

57

Risk Ratio (IV, Random, 95% CI)

0.76 [0.56, 1.05]

Figures and Tables -
Comparison 2. Antifibrinolytic drugs vs placebo or open control
Comparison 3. Platelet transfusion vs open control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death or dependence (mRS 4 to 6) at day 90 Show forest plot

1

190

Risk Ratio (IV, Random, 95% CI)

1.29 [1.04, 1.61]

1.1 Acute antiplatelet‐associated ICH

1

190

Risk Ratio (IV, Random, 95% CI)

1.29 [1.04, 1.61]

2 Death by day 90 Show forest plot

1

190

Risk Ratio (IV, Random, 95% CI)

1.42 [0.88, 2.28]

2.1 Acute antiplatelet‐associated ICH

1

190

Risk Ratio (IV, Random, 95% CI)

1.42 [0.88, 2.28]

3 All serious adverse events Show forest plot

1

190

Risk Ratio (IV, Random, 95% CI)

1.46 [0.98, 2.16]

3.1 Acute antiplatelet‐associated ICH

1

190

Risk Ratio (IV, Random, 95% CI)

1.46 [0.98, 2.16]

4 Thromboembolic serious adverse events Show forest plot

1

190

Risk Ratio (IV, Random, 95% CI)

3.84 [0.44, 33.68]

4.1 Acute antiplatelet‐associated ICH

1

190

Risk Ratio (IV, Random, 95% CI)

3.84 [0.44, 33.68]

5 Intracerebral haemorrhage growth by 24 hours Show forest plot

1

190

Risk Ratio (IV, Random, 95% CI)

1.11 [0.56, 2.20]

5.1 Acute antiplatelet‐associated ICH

1

190

Risk Ratio (IV, Random, 95% CI)

1.11 [0.56, 2.20]

Figures and Tables -
Comparison 3. Platelet transfusion vs open control
Comparison 4. Blood clotting factors vs fresh frozen plasma

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Death by day 90 Show forest plot

1

5

Risk Ratio (IV, Random, 95% CI)

0.27 [0.02, 3.74]

1.1 Acute anticoagulant‐associated ICH

1

5

Risk Ratio (IV, Random, 95% CI)

0.27 [0.02, 3.74]

2 All serious adverse events Show forest plot

1

5

Risk Ratio (IV, Random, 95% CI)

0.27 [0.02, 3.74]

2.1 Acute anticoagulant‐associated ICH

1

5

Risk Ratio (IV, Random, 95% CI)

0.27 [0.02, 3.74]

Figures and Tables -
Comparison 4. Blood clotting factors vs fresh frozen plasma