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  

作　　者：Ximing Nie Jingyi Liu Dacheng Liu Qi Zhou Wanying Duan Yuehua Pu Zhonghua Yang Miao Wen Haixin Sun Wenzhi Wang Shengjun Sun Hongqiu Gu Liping Liu 

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

出　　处：《Stroke & Vascular Neurology》2021年第2期170-179,共10页卒中与血管神经病学（英文）

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 

分 类 号：R743.3[医药卫生—神经病学与精神病学]