Nickalus R Khan1, Georgios Tsivgoulis2, Siang Liao Lee2, G Morgan Jones2, Cain S Green2, Aristeidis H Katsanos2, Paul Klimo2, Adam S Arthur2, Lucas Elijovich2, Andrei V Alexandrov2. 1. From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.). nkhan4@uthsc.edu. 2. From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
Abstract
BACKGROUND AND PURPOSE: Intraventricular hemorrhage is associated with high mortality and poor functional outcome. The use of intraventricular fibrinolytic (IVF) therapy as an intervention in intraventricular hemorrhage is an evolving therapy with conflicting reports in the literature. The goal of this study is to investigate the impact of IVF on mortality, functional outcome, ventriculitis, shunt dependence, and rehemorrhage. METHODS: During March and April 2014, a systematic literature search was performed identifying 1359 articles. Of these, 24 met inclusion criteria. A random effects meta-analysis was performed using both pooled and subset analysis based on study type. RESULTS: Our meta-analysis demonstrated that IVF reduced mortality in intraventricular hemorrhage by nearly half (relative risk [RR], 0.55; 95% confidence interval [CI], 0.42-0.71; P<0.00001), increased the likelihood of good functional outcome by 66% (RR, 1.66; 95% CI, 1.27-2.19; P=0.0003), and also decreased the rate of shunt dependence (RR, 0.62; 95% CI, 0.42-0.93; P=0.02). IVF was not found to be associated with increased rates of ventriculitis (RR=1.46; 95% CI, 0.77-2.76; P=0.25) or rehemorrhage (RR=1.06; 95% CI, 0.66-1.70; P=0.80). We detected no evidence of publication bias. CONCLUSIONS: Our meta-analysis showed that IVF is safe and could be an effective strategy for the treatment of intraventricular hemorrhage. It may reduce mortality, improve functional outcome, and diminish the need for permanent ventricular shunting, while not increasing the risk of ventriculitis or rehemorrhage.
BACKGROUND AND PURPOSE:Intraventricular hemorrhage is associated with high mortality and poor functional outcome. The use of intraventricular fibrinolytic (IVF) therapy as an intervention in intraventricular hemorrhage is an evolving therapy with conflicting reports in the literature. The goal of this study is to investigate the impact of IVF on mortality, functional outcome, ventriculitis, shunt dependence, and rehemorrhage. METHODS: During March and April 2014, a systematic literature search was performed identifying 1359 articles. Of these, 24 met inclusion criteria. A random effects meta-analysis was performed using both pooled and subset analysis based on study type. RESULTS: Our meta-analysis demonstrated that IVF reduced mortality in intraventricular hemorrhage by nearly half (relative risk [RR], 0.55; 95% confidence interval [CI], 0.42-0.71; P<0.00001), increased the likelihood of good functional outcome by 66% (RR, 1.66; 95% CI, 1.27-2.19; P=0.0003), and also decreased the rate of shunt dependence (RR, 0.62; 95% CI, 0.42-0.93; P=0.02). IVF was not found to be associated with increased rates of ventriculitis (RR=1.46; 95% CI, 0.77-2.76; P=0.25) or rehemorrhage (RR=1.06; 95% CI, 0.66-1.70; P=0.80). We detected no evidence of publication bias. CONCLUSIONS: Our meta-analysis showed that IVF is safe and could be an effective strategy for the treatment of intraventricular hemorrhage. It may reduce mortality, improve functional outcome, and diminish the need for permanent ventricular shunting, while not increasing the risk of ventriculitis or rehemorrhage.
Authors: Georgios Tsivgoulis; Ramin Zand; Aristeidis H Katsanos; Vijay K Sharma; Nitin Goyal; Christos Krogias; Apostolos Safouris; Konstantinos Vadikolias; Konstantinos Voumvourakis; Anne W Alexandrov; Marc D Malkoff; Andrei V Alexandrov Journal: J Neurol Date: 2015-06-25 Impact factor: 4.849
Authors: J Kornbluth; S Nekoovaght-Tak; N Ullman; J R Carhuapoma; D F Hanley; W Ziai Journal: AJNR Am J Neuroradiol Date: 2015-07-30 Impact factor: 3.825
Authors: Nitin Goyal; Georgios Tsivgoulis; Ramin Zand; Vijay K Sharma; Kristian Barlinn; Shailesh Male; Aristeidis H Katsanos; Ulf Bodechtel; Sulaiman Iftikhar; Adam Arthur; Lucas Elijovich; Anne W Alexandrov; Andrei V Alexandrov Journal: Neurology Date: 2015-09-25 Impact factor: 9.910