Outcome
after spontaneous intracerebral hemorrhage (ICH) is worsened by
hematoma growth, which occurs in up to one third of patients within 24
hours of onset. Early hemostatic therapy might improve outcome by
limiting hematoma growth.
Objectives
This
updated review aimed to examine the efficacy and safety of individual
classes of hemostatic therapies in adults with acute spontaneous ICH,
according to the type of antithrombotic drug taken immediately before
ICH onset (ie, anticoagulant, antiplatelet, or none).
1
Methods
Search Methods
We
searched the Cochrane Stroke Trials Register, MEDLINE, EMBASE,
reference list of articles, and international trial registers up to
November 2017.
Selection Criteria
We
included randomized controlled trials (RCTs) of any hemostatic
intervention for acute spontaneous ICH, compared with placebo, open
control, or an active comparator, reporting relevant clinical outcomes.
Data Collection and Analysis
Two
authors independently extracted data, assessed risk of bias, and
contacted corresponding authors of eligible RCTs for specific data if
they were not provided in the published report of an RCT.
Main Results
We
included 12 RCTs involving 1732 participants. There were 7 RCTs of
clotting factors versus placebo/control (1480 participants), 3 RCTs of
antifibrinolytic drugs versus placebo/control (57 participants), 1 RCT
of platelet transfusion versus control (190 participants) and 1 RCT of
clotting factors versus fresh frozen plasma (5 participants). We could
not include 2 eligible RCTs of clotting factors versus fresh frozen
plasma because they presented aggregate data for ICH and other types of
intracranial hemorrhage. In 1 RCT of platelet transfusion versus control
for antiplatelet-related ICH, there was a significant increase in death
or dependence (modified Rankin Scale score 4–6) at day 90 (70/97 versus
52/93; risk ratio 1.29; 95% confidence interval 1.04–1.61). There were
no significant differences in death or dependency at day 90 for clotting
factors versus placebo/control (risk ratio 0.87; 95% confidence
interval 0.70–1.07;
Figure)
and antifibrinolytic drugs versus placebo/control (risk ratio 1.25; 95%
confidence interval 0.57–2.75) for acute spontaneous ICH. There was no
significant difference in death at day 90 for clotting factors versus
fresh frozen plasma for anticoagulant-related ICH (risk ratio 0.27; 95%
confidence interval 0.02–3.74).
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