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EBS presentation 1
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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EBS presentation 2
Clinical case
• Male, 6th decade, collapse, GCS 3• CT – Fisher grade IV SAH. Ruptured AcomA
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EBS presentation 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 outcomes
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EBS presentation 4
Search strategy
• Medline, Embase, Scopus
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EBS presentation 5
Medline
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EBS presentation 6
Medline – Mary’s edition
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EBS presentation 7
Embase
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EBS presentation 8
Embase
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EBS presentation 9
Embase – Mary’s edition
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EBS presentation 10
Scopus
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EBS presentation 11
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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EBS presentation 12
Summary of papers
• Excel table
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EBS presentation 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.