Journal of Korean Neurosurgical Society

  • 제64권2호
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  • Pages.207-216
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  • 2021
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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The Effect of Locally Administered Fibrinolytic Drugs Following Aneurysmal Subarachnoid Hemorrhage : A Meta-Analysis with Eight Randomized Controlled Studies

  • Jang, Kyoung Min (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Choi, Hyun Ho (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Nam, Taek Kyun (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Park, Yong Sook (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Kwon, Jeong Taik (Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Byun, Jun Soo (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Hwang, Doyeon (Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital)
  • 투고 : 2020.06.03
  • 심사 : 2020.07.29
  • 발행 : 2021.03.01
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초록

Objective : Rapid dissolution of blood clots reduces vasospasm and hydrocephalus after subarachnoid hemorrhage (SAH), and locally administered fibrinolytic drugs (LAFDs) could facilitate the dissolution. However, the efficacy of LAFDs remains controversial. The aim of this meta-analysis was to determine the efficacy of LAFDs for vasospasm and hydrocephalus and in clinical outcomes. Methods : From PubMed, EMBASE, and Cochrane database, data were extracted by two authors. Meta-analysis was performed using a random effect model. Inclusion criteria were patients who had LAFDs with urokinase-type or recombinant tissue-plasminogen activator after SAH in comparison with medically untreated patients with fibrinolytic drugs. We only included randomized controlled trials (RCTs) in this analysis. The outcomes of interest were vasospasm, hydrocephalus, mortality, and 90-day unfavorable functional outcome. Results : Data from eight RCTs with 550 patients were included. Pooled-analysis revealed that the LAFDs were significantly associated with lower rates of vasospasm (LAFDs group vs. control group, 26.5% vs. 39.2%; odds ratio [OR], 0.48; 95% confidence interval [CI], 0.32-0.73); hydrocephalus (LAFDs group vs. control group, 26.0% vs. 31.6%; OR, 0.54; 95% CI, 0.32-0.91); and mortality (LAFDs group vs. control group, 10.5% vs. 15.7%; OR, 0.58; 95% CI, 0.34-0.99). The proportion of 90-day unfavorable outcomes was lower in the LAFDs group (LAFDs group vs. control group, 32.7% vs. 43.5%; OR, 0.55; 95% CI, 0.37-0.80). Conclusion : This meta-analysis with eight RCTs indicated that LAFDs were significantly associated with lower rates of vasospasm and hydrocephalus after SAH. Thus, LAFDs could consequently reduce mortality and improve clinical outcome after SAH.

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참고문헌

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