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The use tissue plasminogen activator in Fisher grade IV SAH

Khalid Alsahli

Macquarie Neurosurgery

Evidence Based Surgery presentation

Date: 10/10/2013

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Clinical case

• Male, 6th decade, collapse, GCS 3• CT – Fisher grade IV SAH. Ruptured AcomA

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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 outcomes

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Search strategy

• Medline, Embase, Scopus

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Medline

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Medline – Mary’s edition

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Embase

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Embase

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Embase – Mary’s edition

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Scopus

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Search cont.

• Excluded case reports, unrelated topics.• 7 articles were identified• 3 were excluded – included patients with ICH

and non-aneurysmal SAH.

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Summary of papers

• Excel table

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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.