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Hyperbaric oxygen therapy for acute ischaemic stroke.
CONCLUSIONS: We found no good evidence to show that HBOT improves clinical outcomes when applied during acute presentation of ischaemic stroke. Although evidence from the 11 RCTs is insufficient to provide clear guidelines for practice, the possibility of clinical benefit has not been excluded. Further research is required to better define the role of HBOT in this condition. PMID: 25387992 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 12, 2014 Category: Journals (General) Authors: Bennett MH, Weibel S, Wasiak J, Schnabel A, French C, Kranke P Tags: Cochrane Database Syst Rev Source Type: research

Interventions for deliberately altering blood pressure in acute stroke.
CONCLUSIONS: There is insufficient evidence that lowering blood pressure during the acute phase of stroke improves functional outcome. It is reasonable to withhold blood pressure-lowering drugs until patients are medically and neurologically stable, and have suitable oral or enteral access, after which drugs can than be reintroduced. In people with acute stroke, CCBs, ACEI, ARA, beta blockers and NO donors each lower blood pressure while phenylephrine probably increases blood pressure. Further trials are needed to identify which people are most likely to benefit from early treatment, in particular whether treatment started...
Source: Cochrane Database of Systematic Reviews - October 28, 2014 Category: Journals (General) Authors: Bath PM, Krishnan K Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers for preventing stroke recurrence.
CONCLUSIONS: To date, no available evidence supports the routine use of beta-blockers for secondary prevention after stroke or TIA. More studies with larger samples are needed. PMID: 25317988 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 15, 2014 Category: Journals (General) Authors: De Lima LG, Saconato H, Atallah AN, da Silva EM Tags: Cochrane Database Syst Rev Source Type: research

Haemodilution for acute ischaemic stroke.
CONCLUSIONS: The overall results of this review showed no clear evidence of benefit of haemodilution therapy for acute ischaemic stroke.These results are compatible with no persuasive beneficial evidence of haemodilution therapy for acute ischaemic stroke. This therapy has not been proven to improve survival or functional outcome. PMID: 25159027 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 27, 2014 Category: Journals (General) Authors: Chang TS, Jensen MB Tags: Cochrane Database Syst Rev Source Type: research

Gamma aminobutyric acid (GABA) receptor agonists for acute stroke.
CONCLUSIONS: This review does not provide the evidence to support the use of GABA receptor agonists (chlormethiazole or diazepam) for the treatment of patients with acute ischemic or hemorrhagic stroke. Chlormethiazole appeared to be beneficial in improving functional independence in patients with TACS according to the subgroup analysis, but this result must be interpreted with great caution. More well-designed RCTs with large samples of TACS would be required for further confirmation. However, somnolence and rhinitis are frequent adverse events related to chlormethiazole. PMID: 25097101 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 6, 2014 Category: Journals (General) Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Thrombolysis for acute ischaemic stroke.
CONCLUSIONS: Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial haemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up). Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracrani...
Source: Cochrane Database of Systematic Reviews - August 3, 2014 Category: Journals (General) Authors: Wardlaw JM, Murray V, Berge E, Del Zoppo GJ Tags: Cochrane Database Syst Rev Source Type: research

Stem cell therapy for chronic ischaemic heart disease and congestive heart failure.
CONCLUSIONS: This systematic review and meta-analysis found moderate quality evidence that BMSC treatment improves LVEF. Unlike in trials where BMSC were administered following acute myocardial infarction (AMI), we found some evidence for a potential beneficial clinical effect in terms of mortality and performance status in the long term (after at least one year) in people who suffer from chronic IHD and heart failure, although the quality of evidence was low. PMID: 24777540 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 3, 2014 Category: Journals (General) Authors: Fisher SA, Brunskill SJ, Doree C, Mathur A, Taggart DP, Martin-Rendon E Tags: Cochrane Database Syst Rev Source Type: research

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.
CONCLUSIONS: Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes. The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors. We identified a large number of ongoing studies, suggesting that research in this area is increasing. The use of standardised outcome measures would facilitate the synthesis of future research findings. PMID: 24789063 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 2, 2014 Category: Journals (General) Authors: Lager KE, Mistri AK, Khunti K, Haunton VJ, Sett AK, Wilson AD Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulation versus placebo for heart failure in sinus rhythm.
CONCLUSIONS: Based on the two major randomised trials (HELAS 2006; WASH 2004), there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm. Although oral anticoagulation is indicated in certain groups of patients with heart failure (for example those with atrial fibrillation), the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm. PMID: 24683002 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 28, 2014 Category: Journals (General) Authors: Lip GY, Shantsila E Tags: Cochrane Database Syst Rev Source Type: research

Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation.
CONCLUSIONS: DTIs were as efficacious as VKAs for the composite outcome of vascular death and ischaemic events and only the dose of dabigatran 150 mg twice daily was found to be superior to warfarin. DTIs were associated with fewer major haemorrhagic events, including haemorrhagic strokes. Adverse events that led to discontinuation of treatment occurred more frequently with the DTIs. We detected no difference in death from all causes. PMID: 24677203 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 27, 2014 Category: Journals (General) Authors: Salazar CA, Del Aguila D, Cordova EG Tags: Cochrane Database Syst Rev Source Type: research

Oral antiplatelet therapy for acute ischaemic stroke.
CONCLUSIONS: Antiplatelet therapy with aspirin 160 mg to 300 mg daily, given orally (or by nasogastric tube or per rectum in people who cannot swallow) and started within 48 hours of onset of presumed ischaemic stroke, reduced the risk of early recurrent ischaemic stroke without a major risk of early haemorrhagic complications; long-term outcomes were improved. PMID: 24668137 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 26, 2014 Category: Journals (General) Authors: Sandercock PA, Counsell C, Tseng MC, Cecconi E Tags: Cochrane Database Syst Rev Source Type: research

Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke.
CONCLUSIONS: The available trial evidence showed that, for individuals with acute ischaemic stroke, GP IIb-IIIa inhibitors are associated with a significant risk of intracranial haemorrhage with no evidence of any reduction in death or disability in survivors. These data do not support their routine use in clinical practice. The conclusion is driven by trials of Abciximab, which contributed 89% of the total number of study participants considered. PMID: 24609741 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 8, 2014 Category: Journals (General) Authors: Ciccone A, Motto C, Abraha I, Cozzolino F, Santilli I Tags: Cochrane Database Syst Rev Source Type: research

Insulin for glycaemic control in acute ischaemic stroke.
CONCLUSIONS: After updating the results of our previous review, we found that the administration of intravenous insulin with the objective of maintaining serum glucose within a specific range in the first hours of acute ischaemic stroke does not provide benefit in terms of functional outcome, death, or improvement in final neurological deficit and significantly increased the number of hypoglycaemic episodes. Specifically, those people whose glucose levels were maintained within a tighter range with intravenous insulin experienced a greater risk of symptomatic and asymptomatic hypoglycaemia than those people in the control ...
Source: Cochrane Database of Systematic Reviews - January 23, 2014 Category: Journals (General) Authors: Bellolio MF, Gilmore RM, Ganti L Tags: Cochrane Database Syst Rev Source Type: research

Management of faecal incontinence and constipation in adults with central neurological diseases.
CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low methodological quality. The clinical significance of some of the research findings presented here is difficult to interpret, not least because each intervention has only been addressed in individual trials, against control rather than compared against each other, and the interventions are very different from each other.There was very limited evidence from individual trials in favour of a bulk-forming laxative (psyllium), an isosmotic macrogol l...
Source: Cochrane Database of Systematic Reviews - January 13, 2014 Category: Journals (General) Authors: Coggrave M, Norton C, Cody JD Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in patients with stroke or transient ischaemic attack.
CONCLUSIONS: PPAR-γ agonists were demonstrated to reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and improve insulin sensitivity and the stabilisation of carotid plaques. There is evidence of limited quality that they are well-tolerated. However, the conclusions should be interpreted with caution considering the small number and the quality of the included studies. In future, well-designed, double-blind RCTs with large samples are required to test the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular ev...
Source: Cochrane Database of Systematic Reviews - January 8, 2014 Category: Journals (General) Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

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