Haemostatic therapies for acute spontaneous intracerebral haemorrhage

Rustam Al‐Shahi Salman; Zhe Kang Law; Philip M Bath; Thorsten Steiner; Nikola Sprigg

doi:10.1002/14651858.CD005951.pub4

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

Study flow diagram

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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.

Ir a la figura de la revisiónAbrir en una pestaña nueva

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.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.4

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.5

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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.

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

Ir a la tabla de la revisión

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.

Summary of findings 2. Antifibrinolytic drugs versus placebo

Ir a la tabla de la revisión

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.

Summary of findings 3. Platelet transfusion versus open control

Ir a la tabla de la revisión

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

Summary of findings 4. Blood clotting factors versus fresh frozen plasma

Ir a la tabla de la revisión

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]

Comparison 1. Blood clotting factors vs placebo or open control

Ir a la tabla de la revisión

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]

Comparison 2. Antifibrinolytic drugs vs placebo or open control

Ir a la tabla de la revisión

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]

Comparison 3. Platelet transfusion vs open control

Ir a la tabla de la revisión

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]

Comparison 4. Blood clotting factors vs fresh frozen plasma

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet