t pa in sah

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  • 1.The use tissue plasminogen activator in Fisher grade IV SAH Khalid Alsahli Macquarie Neurosurgery Evidence Based Surgery presentation Date: 10/10/2013EBS presentation1

2. Clinical case Male, 6th decade, collapse, GCS 3 CT Fisher grade IV SAH. Ruptured AcomAEBS presentation2 3. Searchable question (PICO format) In patients with intraventricular extension of aneurysmal subarachnoid haemorrhage, Does the use intraventricular tPA improve outcomes? P: Patients with intraventricular extension of aneurysmal subarachnoid haemorrhage. I: Intraventricular tPA. C: O: Treatment outcomesEBS presentation3 4. Search strategy Medline, Embase, ScopusEBS presentation4 5. MedlineEBS presentation5 6. Medline Marys editionEBS presentation6 7. EmbaseEBS presentation7 8. EmbaseEBS presentation8 9. Embase Marys editionEBS presentation9 10. ScopusEBS presentation10 11. Search cont. Excluded case reports, unrelated topics. 7 articles were identified 3 were excluded included patients with ICH and non-aneurysmal SAH.EBS presentation11 12. Summary of papers Excel tableEBS presentation12 13. Conclusions tPA accelerates intraventricular clot resolution. Not enough evidence to support its usage to improve outcomes. Few studies, need multicenter RCTs studies with larger sample size.EBS presentation13