Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome

Neurology ◽  
2020 ◽  
Vol 95 (14) ◽  
pp. 632-643 ◽  
Author(s):  
Andrea Morotti ◽  
Francesco Arba ◽  
Gregoire Boulouis ◽  
Andreas Charidimou
Keyword(s):  
Intracerebral Hemorrhage ◽  
Randomized Controlled Trials ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Poor Outcome ◽  
Increased Risk ◽  
Noncontrast Ct

ObjectiveTo provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis.MethodsWe searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3–6 or 4–6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker.ResultsWe included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42–9.64 and OR = 5.26, 95% CI = 1.75–15.76), swirl sign (OR = 3.33, 95% CI = 2.42–4.60 and OR = 3.70; 95% CI = 2.47–5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71–4.39 and OR = 2.80; 95% CI = 1.78–4.39), blend sign (OR = 3.49; 95% CI = 2.20–5.55 and OR = 2.21; 95% CI 1.16–4.18), hypodensities (OR = 3.47; 95% CI = 2.18–5.50 and OR = 2.94; 95% CI = 2.28–3.78), irregular shape (OR = 2.01, 95% CI = 1.27–3.19 and OR = 3.43; 95% CI = 2.33–5.03), and island sign (OR = 7.87, 95% CI = 2.17–28.47 and OR = 6.05, 95% CI = 4.44–8.24).ConclusionOur results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.

scholarly journals Early Tranexamic Acid in Intracerebral Hemorrhage: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Xu Jiao ◽  
Mingfei Li ◽  
Lulu Li ◽  
Xinyu Hu ◽  
Xiaohui Guo ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Publication Bias ◽  
Intracranial Hemorrhage ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Poor Outcome

Objective: Intracranial hemorrhage (ICH) is a common complication of traumatic brain, in which tranexamic acid has been recommended as an additional therapy to prevent a second bleeding. However, the effect of early administration of tranexamic acid for ICH patients remains controversial.Methods: A systematic search was performed in Cochrane Library, Medline, Embase, and Web of Science. Poor outcome refers to significant hemorrhage growth, new intracranial hemorrhage, new focal cerebral ischaemic lesions, the need for neurosurgery, or death. Study heterogeneity and publication bias were estimated.Results: Seven randomized controlled trials involving 3,192 participants were included in our meta-analysis. Tranexamic acid administration in ICH patients was associated with better outcomes of hematoma expansion (odd ratios [OR] 0.79; 95% confidence interval (CI) CI, 0.67–0.93; I2 = 0%; P = 0.006) and growth of hemorrhagic lesions (weighted mean difference [WMD], −1.97 ml; 95% CI, −2.94 to −1.00; I2 = 14%; P < 0.001) than the placebo. No difference was found between the mortality, poor outcome, neurosurgical intervention, new bleeding, and the duration of hospital stay. Moreover, no publication bias was found.Conclusion: Our analysis reveals that the early treatment with tranexamic acid can significantly reduce the incidence of hematoma expansion and the volume of hemorrhagic lesion, but does not exert considerable effects on mortality, poor outcome, neurosurgery, rebleeding, and the duration of stay.

scholarly journals The Function of Tranexamic Acid to Prevent Hematoma Expansion After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis From Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Zeya Yan ◽  
Shujun Chen ◽  
Tao Xue ◽  
Xin Wu ◽  
Zhaoming Song ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Statistical Difference ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Hematoma Volume ◽  
Randomized Controlled

Objectives: The clinical results caused by spontaneous intracerebral hemorrhage (ICH) are disastrous to most patient. As tranexamic acid (TXA) has been proved to decrease the influence of ICH, we conducted this research to explore the function of TXA for the prognosis of ICH compared with placebo.Methods: We searched MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov for randomized controlled trials (RCTs) that were performed to evaluate TXA vs. placebo for ICH up to February 2021. The data were assessed by Review Manager 5.3 software. The risk ratio (RR) and mean difference were analyzed using dichotomous outcomes and continuous outcomes, respectively, with a fixed effect model.Results: We collected 2,479 patients from four RCTs. Then, we took the change of hematoma volume, modified Rankin Scale (mRS), and adverse events as evaluation standard of the treatment for ICH. Through statistical analysis, we found that there is no obvious hematoma expansion effect after the application of TXA (RR = 1.05), and we proceeded the quantitative analysis of percentage change in hematoma volume from baseline, indicating that TXA could inhibit the expansion of hematoma volume (RR = −2.02) compared with placebo. However, according to the outcomes of mRS (0–1, RR = 1.04; 0–2, RR = 0.96), TXA cannot improve neurological functional prognosis. As for the security outcomes—mortality (RR = 1.02), thromboembolic events (RR = 0.99), neurological deterioration (RR = 0.92), infection (RR = 0.86), and craniotomy (RR = 0.41), there seems exist no statistical difference between TXA and placebo.Conclusions: TXA has an advantage in the aspect of preventing hematoma expansion compared with placebo for ICH, but cannot illustrate the efficacy of TXA in improving neurological functional prognosis, which still needs more researches with large sample sizes. Moreover, for safety, we did not find obvious statistical difference between TXA and placebo.

scholarly journals Poly(ADP-Ribose) Polymerase Inhibitors (PARPi) for Patients With Advanced Breast Cancer: a Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
YongCheng Su ◽  
XiaoGang Zheng
Keyword(s):  
Breast Cancer ◽  
Randomized Controlled Trials ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Parp Inhibitors ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Grade 3

Abstract BACKGROUND: Poly(ADP–ribose) polymerase (PARP) inhibitors are new class of drugs that are currently being studied in several malignancies. However, datas about the efficacy and safety of the PARP inhibitors are limited. Therefore, we conducted a meta-analysis of randomized controlled trials (RCT) in patients with breast cancer.METHODS: Pubmed/Medline, Embase, Cochrane Library, and abstracts presented at the annual meeting of the American Society of Clinical Oncology (ASCO) were searched for articles published from 2000 to June 2018.Summary incidences and the RR, HR with 95% confidence intervals, were calculated by using a random-effects or fixed-effects model.RESULTS: The summary HR indicated PARPi was not associated with OS (HR=0.83, 95%CI 0.66–1.06, Z=1.49, P=0.14), while it could significantly improve PFS ande time to deterioration (TTD) of global health status/quality of life(GHS/QoL) as compared with traditional standard therapy, the HR was 0.60(95%CI 0.50-0.72; Z=5.52, P＜0.00001) and 0.4 (95%CI 0.29–0.54,z=5.80 ,p=0.000),respectively.The RR of grade 3 or more anemia ,fatigue and headache was 3.02 (95% CI, 0.69–13.17;p = 0.14,,I2=90%),0.77 (95%CI, 0.34–1.73;p=0.52,I2=7%) and 1.13 (95% CI,0.30–4.18;p=0.86,I2=0%),respectively.CONCLUSION: The findings of this meta-analysis showed that PARPi has no significant effect on OS, while it could significantly improve in PFS and TTD of GHS/QoL for patients with advanced or metastatic breast cancer.Furthermore,our findings also demonstrated that the PARPi treatment is connected with an increased risk of grade 3 or more anemia adverse events.

Abstract WP349: Updated Meta-Analysis of Randomized Controlled Trials Investigating Blood-Pressure Lowering for Acute Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Gregoire Boulouis ◽  
Andrea Morotti ◽  
Joshua N Goldstein ◽  
Andreas Charidimou
Keyword(s):  
Blood Pressure ◽  
Randomized Controlled Trials ◽  
Standard Treatment ◽  
Meta Analysis ◽  
Class I ◽  
Hematoma Expansion ◽  
Controlled Trials ◽  
Level Of Evidence ◽  
Treatment Protocols ◽  
Randomized Controlled

Objective: We performed a meta-analysis of randomized controlled trials (RCTs) to assess whether intensive blood pressure (BP) lowering in acute intracerebral haemorrhage (ICH) patients is safe and effective in improving clinical outcomes. Methods: We searched PubMed, EMBASE and the Cochrane databases for relevant RCTs and calculated pooled odds ratios (OR) for 3-month mortality (safety outcome) and 3-month death or dependency (efficacy outcome), in acute ICH patients randomized to either intensive BP-lowering vs. standard BP lowering treatment protocols. We also investigated the association between treatment arm and significant ICH expansion at 24h. Random effects models with DerSimonian-Laird weights were used. Results: Five eligible studies including 4360 acute ICH patients were pooled in meta-analysis. The risk of 3-month mortality was similar between patients randomized to intensive BP-lowering treatment vs. standard BP-lowering treatment (OR: 0.99; 95%CI: 0.82-1.20, p=0.909). Intensive BP-lowering treatment showed a (non-significant) trend for an association with lower 3-month death or dependency risk compared to standard treatment (OR: 0.91; 95%CI: 0.80-1.02), p=0.106). Intensive BP-reduction was associated with a trend for lower risk of significant ICH expansion compared to standard treatment (OR: 0.82; 95%CI: 0.68-1.00, p=0.056), especially in larger RCTs. Conclusion: For acute ICH patients similar to those included in RCTs and without contraindication to acute BP treatment, intensive acute BP-lowering is safe (Class I; Level of Evidence A), but does not seem to provide an incremental clinical benefit in terms of functional outcomes (Class I; Level of Evidence B). The effect of intensive BP-lowering on significant hematoma expansion at 24 hours warrants further investigation.

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