Fibrinolytic-Facilitated Chronic Subdural Hematoma Drainage—A Systematic Review
| Autor: | Gilberto K.K. Leung, Yip Mang O, Shek Long Tsang |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Cochrane Library 03 medical and health sciences 0302 clinical medicine Hematoma Fibrinolytic Agents medicine Humans Injections Spinal Craniotomy Urokinase business.industry Incidence (epidemiology) medicine.disease Urokinase-Type Plasminogen Activator Surgery Systematic review Chemotherapy Adjuvant Hematoma Subdural Chronic Tissue Plasminogen Activator 030220 oncology & carcinogenesis Observational study Neurology (clinical) business 030217 neurology & neurosurgery Fibrinolytic agent medicine.drug |
| Zdroj: | World Neurosurgery. 150:e408-e419 |
| ISSN: | 1878-8750 |
| Popis: | Background 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. |
| Databáze: | OpenAIRE |
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