PT  - JOURNAL ARTICLE
AU  - Ximing Nie
AU  - Jingyi Liu
AU  - Dacheng Liu
AU  - Qi Zhou
AU  - Wanying Duan
AU  - Yuehua Pu
AU  - Zhonghua Yang
AU  - Miao Wen
AU  - Haixin Sun
AU  - Wenzhi Wang
AU  - Shengjun Sun
AU  - Hongqiu Gu
AU  - Liping Liu
TI  - 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
AID  - 10.1136/svn-2021-000941
DP  - 2021 Jun 01
TA  - Stroke and Vascular Neurology
PG  - 170--179
VI  - 6
IP  - 2
4099  - http://svn.bmj.com/content/6/2/170.short
4100  - http://svn.bmj.com/content/6/2/170.full
SO  - Stroke Vasc Neurol2021 Jun 01; 6
AB  - 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.Data are available upon reasonable request. Data in this article are available upon reasonable request.