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Endovascular thrombectomy and intra-arterial interventions for acute ischaemic stroke
CONCLUSIONS: In individuals with acute ischaemic stroke due to large artery occlusion in the anterior circulation, endovascular thrombectomy can increase the chance of survival with a good functional outcome without increasing the risk of intracerebral haemorrhage or death.PMID:34125952 | DOI:10.1002/14651858.CD007574.pub3
Source: Cochrane Database of Systematic Reviews - June 14, 2021 Category: General Medicine Authors: Melinda B Roaldsen Mirza Jusufovic Eivind Berge Haakon Lindekleiv Source Type: research

Treatments for unruptured intracranial aneurysms
CONCLUSIONS: There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling) for individuals with unruptured intracranial aneurysms. Further randomized trials are required to establish if surgery is a better option than conservative management, and if so, which surgical approach is preferred for which patients. Future studies should include consideration of important characteristics such as participant age, gender, aneurysm size, aneurysm location (anterior circulation and posterior circulation), grade of ischemia (...
Source: Cochrane Database of Systematic Reviews - May 10, 2021 Category: General Medicine Authors: Felipe Gomes de Barros Pontes Edina Mk da Silva Jose Cc Baptista-Silva Vladimir Vasconcelos Source Type: research

Thrombolytic therapy for pulmonary embolism
CONCLUSIONS: Low-certainty evidence suggests that thrombolytics may reduce death following acute pulmonary embolism compared with heparin (the effectiveness was mainly driven by one trial with massive PE). Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause more major and minor haemorrhagic events, including haemorrhagic stroke. More studies of high methodological quality are needed to assess safety and cost effectiveness of thrombolytic therapy for people with pulmonary embolism.PMID:33857326 | DOI:10.1002/14651858.CD004437.pub6
Source: Cochrane Database of Systematic Reviews - April 15, 2021 Category: General Medicine Authors: Zhiliang Zuo Jirong Yue Bi Rong Dong Taixiang Wu Guan J Liu Qiukui Hao Source Type: research

Iron chelators for acute stroke.
CONCLUSIONS: We identified two eligible RCTs for assessment. We could not demonstrate any benefit for the use of iron chelators in spontaneous intracerebral haemorrhage. The added value of iron-chelating therapy in people with ischaemic stroke or subarachnoid haemorrhage remains unknown. PMID: 33236783 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 24, 2020 Category: General Medicine Authors: Van der Loo LE, Aquarius R, Teernstra O, Klijn K, Menovsky T, van Dijk JMC, Bartels R, Boogaarts HD Tags: Cochrane Database Syst Rev Source Type: research

Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack.
CONCLUSIONS: Multiple antiplatelet agents are more effective in reducing stroke recurrence but increase the risk of haemorrhage compared to one antiplatelet agent. The benefit in reduction of stroke recurrence seems to outweigh the harm for dual antiplatelet agents initiated in the acute setting and continued for one month. There is lack of evidence regarding multiple versus multiple antiplatelet agents. Further studies are required in different populations to establish comprehensive safety profiles and long-term outcomes to establish duration of therapy. PMID: 32813275 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - August 16, 2020 Category: General Medicine Authors: Naqvi IA, Kamal AK, Rehman H Tags: Cochrane Database Syst Rev Source Type: research

Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis.
CONCLUSIONS: This systematic review provides moderate-quality evidence showing that ET, compared with CMT, in people with recent symptomatic severe intracranial atherosclerotic stenosis probably does not prevent recurrent stroke and appears to carry an increased hazard. The impact of delayed ET intervention (more than three weeks after a qualifying event) is unclear and may warrant further study. PMID: 32789891 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - August 10, 2020 Category: General Medicine Authors: Wang T, Luo J, Wang X, Yang K, Jadhav V, Gao P, Ma Y, Zhao N, Jiao L Tags: Cochrane Database Syst Rev Source Type: research

Withdrawal of antihypertensive drugs in older people.
CONCLUSIONS: There is no evidence of an effect of discontinuing compared with continuing antihypertensives used for hypertension or primary prevention of cardiovascular disease in older adults on all-cause mortality and myocardial infarction. The evidence was low to very low certainty mainly due to small studies and low event rates. These limitations mean that we cannot make any firm conclusions about the effect of deprescribing antihypertensives on these outcomes. Future research should focus on populations with the greatest uncertainty of the benefit:risk ratio for use of antihypertensive medications, such as those with ...
Source: Cochrane Database of Systematic Reviews - June 9, 2020 Category: General Medicine Authors: Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D Tags: Cochrane Database Syst Rev Source Type: research

Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke.
CONCLUSIONS: Moderate-certainty evidence shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity activity. Moderate-certainty evidence also shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity impairment after stroke. Low-certainty evidence suggests that ADLs may not be improved with MP in addition to other treatment versus the other treatment. Low-certainty evidence also suggests that MP versus conventional treatment may not improve upper extremity impairment. Further study is requ...
Source: Cochrane Database of Systematic Reviews - May 24, 2020 Category: General Medicine Authors: Barclay RE, Stevenson TJ, Poluha W, Semenko B, Schubert J Tags: Cochrane Database Syst Rev Source Type: research

Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.
CONCLUSIONS: We found no reliable evidence that SSRIs should be used routinely to promote recovery after stroke. Meta-analysis of the trials at low risk of bias indicate that SSRIs do not improve recovery from stroke. We identified potential improvements in disability only in the analyses which included trials at high risk of bias. A further meta-analysis of large ongoing trials will be required to determine the generalisability of these findings. PMID: 31769878 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 25, 2019 Category: General Medicine Authors: Legg LA, Tilney R, Hsieh CF, Wu S, Lundström E, Rudberg AS, Kutlubaev MA, Dennis M, Soleimani B, Barugh A, Hackett ML, Hankey GJ, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating brain arteriovenous malformations in adults.
CONCLUSIONS: We found moderate-quality evidence from one RCT including adults with unruptured brain AVMs that conservative management was superior to intervention with respect to functional outcome and symptomatic intracranial haemorrhage over one year after randomization. More RCTs will help to confirm or refute these findings. PMID: 31503327 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 9, 2019 Category: General Medicine Authors: Zuurbier SM, Al-Shahi Salman R Tags: Cochrane Database Syst Rev Source Type: research

Marine-derived n-3 fatty acids therapy for stroke.
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention.Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of ad...
Source: Cochrane Database of Systematic Reviews - June 25, 2019 Category: General Medicine Authors: Alvarez Campano CG, Macleod MJ, Aucott L, Thies F Tags: Cochrane Database Syst Rev Source Type: research

Thrombolytic therapy for pulmonary embolism.
CONCLUSIONS: Low-quality evidence suggests that thrombolytics reduce death following acute pulmonary embolism compared with heparin. The included studies used a variety of thrombolytic drugs. Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause major and minor haemorrhagic events and stroke. More high-quality, blinded randomised controlled trials assessing safety and cost-effectiveness of therapies for pulmonary embolism are required. PMID: 30560579 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 18, 2018 Category: General Medicine Authors: Hao Q, Dong BR, Yue J, Wu T, Liu GJ Tags: Cochrane Database Syst Rev Source Type: research

Gamma aminobutyric acid (GABA) receptor agonists for acute stroke.
CONCLUSIONS: This review provides moderate-quality evidence that fails to support the use of GABA receptor agonists (chlormethiazole or diazepam) for the treatment of people with acute stroke. More well-designed RCTs with large samples of participants with total anterior circulation syndrome are required to determine if there are benefits for this subgroup. Somnolence and rhinitis are frequent adverse events related to chlormethiazole. PMID: 30376593 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 30, 2018 Category: General Medicine Authors: Liu J, Zhang J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation.
CONCLUSIONS: This review suggested that an expectant approach to the management of women with severe early onset pre-eclampsia may be associated with decreased morbidity for the baby. However, this evidence was based on data from only six trials. Further large, high-quality trials are needed to confirm or refute these findings, and establish if this approach is safe for the mother. PMID: 30289565 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 5, 2018 Category: General Medicine Authors: Churchill D, Duley L, Thornton JG, Moussa M, Ali HS, Walker KF Tags: Cochrane Database Syst Rev Source Type: research

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