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Article: Fibrinolytic-facilitated chronic subdural hematoma drainage - a systematic review

TitleFibrinolytic-facilitated chronic subdural hematoma drainage - a systematic review
Authors
KeywordsChronic subdural hematoma
Fibrinolytic agents
Tissue plasminogen activator
Urokinase
Issue Date2021
PublisherElsevier Inc. The Journal's web site is located at http://www.worldneurosurgery.org/
Citation
World Neurosurgery, 2021, v. 150, p. e408-e419 How to Cite?
AbstractBackground: The current treatment options for chronic subdural hematoma (CSDH) include burr hole drainage, twist drill drainage, and craniotomy with or without postoperative catheter drainage. Although generally effective, these treatments have continued to be complicated by recurrence, especially in partially hemolyzed or septated hematomas. Recently, interest in the use of fibrinolytic agents as an adjunct to surgical treatment to address this limitation has been increasing. We conducted a systematic review, focusing on the efficacy and safety profile of fibrinolytic agents and compared the different fibrinolytic agents. Methods: The PubMed, EMBASE, CINAHL Plus, and Cochrane Library databases were searched for trials relevant to fibrinolytic administration in the treatment of CSDH. The findings are reported in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The data from 1702 subjects from 6 retrospective observational studies were qualitatively analyzed. In addition, we included 11 case series and reports for discussion. Results: For 1449 patients, the use of urokinase or tissue plasminogen activator improved hematoma drainage and shortened the hospital stay (7.04 days), with an overall hematoma recurrence rate of 1.59%. The incidence of infection, seizure, and intracranial bleeding was 3.18%, 0.80%, and 0.41%, respectively, which compared favorably with previously reported findings for surgical drainage without the use of fibrinolytic agents. Conclusions: The routine use of intrathecal urokinase and tissue plasminogen activator could be a new direction in the management of CSDH. Conclusive clinical evidence is lacking, however, and further prospective controlled studies are warranted to confirm the benefit and safety of this treatment strategy and to identify the optimal agent and dosing regimen.
Persistent Identifierhttp://hdl.handle.net/10722/307729
ISSN
2023 Impact Factor: 1.9
2023 SCImago Journal Rankings: 0.654
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorO, YM-
dc.contributor.authorTsang, SL-
dc.contributor.authorLeung, GKK-
dc.date.accessioned2021-11-12T13:36:58Z-
dc.date.available2021-11-12T13:36:58Z-
dc.date.issued2021-
dc.identifier.citationWorld Neurosurgery, 2021, v. 150, p. e408-e419-
dc.identifier.issn1878-8750-
dc.identifier.urihttp://hdl.handle.net/10722/307729-
dc.description.abstractBackground: The current treatment options for chronic subdural hematoma (CSDH) include burr hole drainage, twist drill drainage, and craniotomy with or without postoperative catheter drainage. Although generally effective, these treatments have continued to be complicated by recurrence, especially in partially hemolyzed or septated hematomas. Recently, interest in the use of fibrinolytic agents as an adjunct to surgical treatment to address this limitation has been increasing. We conducted a systematic review, focusing on the efficacy and safety profile of fibrinolytic agents and compared the different fibrinolytic agents. Methods: The PubMed, EMBASE, CINAHL Plus, and Cochrane Library databases were searched for trials relevant to fibrinolytic administration in the treatment of CSDH. The findings are reported in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The data from 1702 subjects from 6 retrospective observational studies were qualitatively analyzed. In addition, we included 11 case series and reports for discussion. Results: For 1449 patients, the use of urokinase or tissue plasminogen activator improved hematoma drainage and shortened the hospital stay (7.04 days), with an overall hematoma recurrence rate of 1.59%. The incidence of infection, seizure, and intracranial bleeding was 3.18%, 0.80%, and 0.41%, respectively, which compared favorably with previously reported findings for surgical drainage without the use of fibrinolytic agents. Conclusions: The routine use of intrathecal urokinase and tissue plasminogen activator could be a new direction in the management of CSDH. Conclusive clinical evidence is lacking, however, and further prospective controlled studies are warranted to confirm the benefit and safety of this treatment strategy and to identify the optimal agent and dosing regimen.-
dc.languageeng-
dc.publisherElsevier Inc. The Journal's web site is located at http://www.worldneurosurgery.org/-
dc.relation.ispartofWorld Neurosurgery-
dc.subjectChronic subdural hematoma-
dc.subjectFibrinolytic agents-
dc.subjectTissue plasminogen activator-
dc.subjectUrokinase-
dc.titleFibrinolytic-facilitated chronic subdural hematoma drainage - a systematic review-
dc.typeArticle-
dc.identifier.emailLeung, GKK: gkkleung@hku.hk-
dc.identifier.authorityLeung, GKK=rp00522-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.wneu.2021.03.029-
dc.identifier.pmid33722722-
dc.identifier.scopuseid_2-s2.0-85103972463-
dc.identifier.hkuros329849-
dc.identifier.volume150-
dc.identifier.spagee408-
dc.identifier.epagee419-
dc.identifier.isiWOS:000657837500043-
dc.publisher.placeUnited States-

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