T pa in sah

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

EBS presentation 2

Clinical case

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

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

EBS presentation 4

Search strategy

• Medline, Embase, Scopus

EBS presentation 5

Medline

EBS presentation 6

Medline – Mary’s edition

EBS presentation 7

Embase

EBS presentation 8

Embase

EBS presentation 9

Embase – Mary’s edition

EBS presentation 10

Scopus

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.

EBS presentation 12

Summary of papers

• Excel table

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.