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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

查看全文 作　　者：Ximing [1,2]Nie;Jingyi [1,2]Liu;Dacheng [1,2]Liu;Qi [1,2]Zhou;Wanying [1,2]Duan;Yuehua [1,2]Pu;Zhonghua [1,2]Yang;Miao [1,2]Wen;Haixin [3]Sun;Wenzhi [3]Wang;Shengjun [3,4]Sun;Hongqiu [1,2]Gu;Liping [1,2]Liu 高影响力作者 机构地区：[1]Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China;[2]China National Clinical Research Center for Neurological Diseases,Beijing,China;[3]Beijing Neurosurgical Institute,Beijing Tiantan Hospital,Capital Medical University,Beijing,China;[4]Department of Neuroradiology,Beijing Tiantan Hospital,Capital Medical University,Beijing,China高影响力机构 出　　处：《Stroke & Vascular Neurology》索引2021年第6卷第2期,共10页高影响力期刊 基　　金：The study is funded by grants from the Beijing Science and Technology Commission(D141100000114002);National Natural Science Foundation of China(81820108012,81971614);National Key R&D Program of China(2016YFC1307301,2018YFC1312402). 摘　　要：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. 关 键 词：PATIENTS prevention EXPANSION
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