title: Fibrinolysis for intraventricular hemorrhage: an updated meta-analysis and systematic review of the literature.
abstract: OBJECTIVE
  Intraventricular hemorrhage is associated with high mortality and poor functional outcome. The use of intraventricular fibrinolytic (IVF) therapy as an intervention in intraventricular hemorrhage is an evolving therapy with conflicting reports in the literature. The goal of this study is to investigate the impact of IVF on mortality, functional outcome, ventriculitis, shunt dependence, and rehemorrhage.
  
  
  METHODS
  During March and April 2014, a systematic literature search was performed identifying 1359 articles. Of these, 24 met inclusion criteria. A random effects meta-analysis was performed using both pooled and subset analysis based on study type.
  
  
  RESULTS
  Our meta-analysis demonstrated that IVF reduced mortality in intraventricular hemorrhage by nearly half (relative risk [RR], 0.55; 95% confidence interval [CI], 0.42-0.71; P<0.00001), increased the likelihood of good functional outcome by 66% (RR, 1.66; 95% CI, 1.27-2.19; P=0.0003), and also decreased the rate of shunt dependence (RR, 0.62; 95% CI, 0.42-0.93; P=0.02). IVF was not found to be associated with increased rates of ventriculitis (RR=1.46; 95% CI, 0.77-2.76; P=0.25) or rehemorrhage (RR=1.06; 95% CI, 0.66-1.70; P=0.80). We detected no evidence of publication bias.
  
  
  CONCLUSIONS
  Our meta-analysis showed that IVF is safe and could be an effective strategy for the treatment of intraventricular hemorrhage. It may reduce mortality, improve functional outcome, and diminish the need for permanent ventricular shunting, while not increasing the risk of ventriculitis or rehemorrhage.
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.). nkhan4@uthsc.edu.
authors: Nickalus R
authors: NR
authors: Khan
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Georgios
authors: G
authors: Tsivgoulis
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Siang Liao
authors: SL
authors: Lee
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: G Morgan
authors: GM
authors: Jones
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Cain S
authors: CS
authors: Green
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Aristeidis H
authors: AH
authors: Katsanos
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Paul
authors: P
authors: Klimo
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Adam S
authors: AS
authors: Arthur
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Lucas
authors: L
authors: Elijovich
authors: From the Department of Neurosurgery (N.R.K., G.M.J., P.K., A.S.A., L.E.), Department of Neurology (G.T., G.M.J., L.E., A.V.A.), Department of Clinical Pharmacy (G.M.J.), and College of Medicine (C.S.G.), University of Tennessee Health Sciences Center, Memphis; Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece (G.T.); International Clinical Research Center, Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic (G.T.); Feinberg School of Medicine, Northwestern University, Chicago, IL (S.L.L.); Department of Neurology, University of Ioannina, School of Medicine, Ipiros, Greece (A.H.K.); and Semmes-Murphey Neurologic & Spine Institute, Memphis, TN (P.K., A.S.A., L.E.).
authors: Andrei V
authors: AV
authors: Alexandrov
mesh_terms: D002543:Cerebral Hemorrhage / Q000401:mortality* / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D012008:Recurrence; D012306:Risk; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
keywords: fibrinolysis; meta-analysis