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Endovascular coiling versus neurosurgical clipping for people with aneurysmal subarachnoid haemorrhage.
CONCLUSIONS: The evidence in this systematic review comes mainly from one large trial, and long-term follow-up is available only for a subgroup of participants within that trial. For people in good clinical condition with ruptured aneurysms of either the anterior or posterior circulation the data from randomised trials show that, if the aneurysm is considered suitable for both neurosurgical clipping and endovascular coiling, coiling is associated with a better outcome. There is no reliable trial evidence that can be used directly to guide treatment in people with a poor clinical condition. PMID: 30110521 [PubMed - as ...
Source: Cochrane Database of Systematic Reviews - August 15, 2018 Category: General Medicine Authors: Lindgren A, Vergouwen MD, van der Schaaf I, Algra A, Wermer M, Clarke MJ, Rinkel GJ Tags: Cochrane Database Syst Rev Source Type: research

Surgery versus thrombolysis for initial management of acute limb ischaemia.
CONCLUSIONS: There is currently no evidence in favour of either initial thrombolysis or initial surgery as the preferred option in terms of limb salvage, amputation, or death at 30 days, six months, or one year. Low-quality evidence suggests that thrombolysis may be associated with higher risk of haemorrhagic complications and ongoing limb ischaemia (distal embolisation). The higher risk of complications must be balanced against risks of surgery in each individual case. Trial results show no statistical difference in stroke, but the confidence interval is very wide, making it difficult to interpret whether this finding is ...
Source: Cochrane Database of Systematic Reviews - August 10, 2018 Category: General Medicine Authors: Darwood R, Berridge DC, Kessel DO, Robertson I, Forster R Tags: Cochrane Database Syst Rev Source Type: research

Remote ischaemic conditioning for preventing and treating ischaemic stroke.
CONCLUSIONS: We found low-quality evidence that RIC may reduce the risk of recurrent stroke in participants with intracerebral artery stenosis and reduce stroke severity in participants undergoing carotid stenting, but it may increase death or dependence in participants with acute ischaemic stroke who are undergoing intravenous thrombolysis. However, there is considerable uncertainty about these conclusions because of the small number of studies and low quality of the evidence. PMID: 29974450 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Zhao W, Zhang J, Sadowsky MG, Meng R, Ding Y, Ji X Tags: Cochrane Database Syst Rev Source Type: research

Automated monitoring compared to standard care for the early detection of sepsis in critically ill patients.
CONCLUSIONS: It is unclear what effect automated systems for monitoring sepsis have on any of the outcomes included in this review. Very low-quality evidence is only available on automated alerts, which is only one component of automated monitoring systems. It is uncertain whether such systems can replace regular, careful review of the patient's condition by experienced healthcare staff. PMID: 29938790 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 25, 2018 Category: General Medicine Authors: Warttig S, Alderson P, Evans DJ, Lewis SR, Kourbeti IS, Smith AF Tags: Cochrane Database Syst Rev Source Type: research

Haemostatic therapies for acute spontaneous intracerebral haemorrhage.
CONCLUSIONS: Based on moderate-quality evidence from one trial, platelet transfusion seems hazardous in comparison to standard care for adults with antiplatelet-associated ICH.We were unable to draw firm conclusions about the efficacy and safety of blood clotting factors for acute spontaneous ICH with or without surgery, antifibrinolytic drugs for acute spontaneous ICH, and clotting factors versus fresh frozen plasma for acute spontaneous ICH associated with anticoagulant drug use.Further RCTs are warranted, and we await the results of the 10 ongoing RCTs with interest. PMID: 29664991 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 17, 2018 Category: General Medicine Authors: Al-Shahi Salman R, Law ZK, Bath PM, Steiner T, Sprigg N Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for acute stroke.
CONCLUSIONS: This updated review indicates that apparently improved outcomes with acupuncture in acute stroke are confounded by the risk of bias related to use of open controls. Adverse events related to acupuncture were reported to be minor and usually did not result in stopping treatment. Future studies are needed to confirm or refute any effects of acupuncture in acute stroke. Trials should clearly report the method of randomization, concealment of allocation, and whether blinding of participants, personnel, and outcome assessors was achieved, while paying close attention to the effects of acupuncture on long-term funct...
Source: Cochrane Database of Systematic Reviews - March 30, 2018 Category: General Medicine Authors: Xu M, Li D, Zhang S Tags: Cochrane Database Syst Rev Source Type: research

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation.
CONCLUSIONS: Treatment with factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in people with AF. The absolute effect of factor Xa inhibitors compared with warfarin treatment was, however, rather small. Factor Xa inhibitors also reduced the number of ICHs, all-cause deaths and major bleedings compared with warfarin, although the evidence for a reduction in the latter is less robust. PMID: 29509959 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 6, 2018 Category: General Medicine Authors: Bruins Slot KM, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic therapy for preventing infections in people with acute stroke.
CONCLUSIONS: Preventive antibiotics had no effect on functional outcome or mortality, but significantly reduced the risk of 'overall' infections. This reduction was driven mainly by prevention of urinary tract infection; no effect for pneumonia was found. PMID: 29355906 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - January 22, 2018 Category: General Medicine Authors: Vermeij JD, Westendorp WF, Dippel DW, van de Beek D, Nederkoorn PJ Tags: Cochrane Database Syst Rev Source Type: research

Embolisation for pulmonary arteriovenous malformation.
CONCLUSIONS: There is no evidence from randomised controlled trials for embolisation of pulmonary arteriovenous malformations. However, randomised controlled trials are not always feasible on ethical grounds. Accumulated data from observational studies suggest that embolisation is a safe procedure which reduces morbidity and mortality. A standardised approach to reporting with long-term follow-up through registry studies can help to strengthen the evidence for embolisation in the absence of randomised controlled trials. PMID: 29298459 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - January 4, 2018 Category: General Medicine Authors: Hsu CC, Kwan GN, Evans-Barns H, van Driel ML Tags: Cochrane Database Syst Rev Source Type: research

Antithrombotic treatment after stroke due to intracerebral haemorrhage.
CONCLUSIONS: There is insufficient evidence from RCTs to support or discourage the use of antithrombotic treatment after ICH. RCTs comparing starting versus avoiding antiplatelet or anticoagulant drugs after ICH appear justified and are needed in clinical practice. PMID: 28540976 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 25, 2017 Category: General Medicine Authors: Perry LA, Berge E, Bowditch J, Forfang E, Rønning OM, Hankey GJ, Villanueva E, Al-Shahi Salman R Tags: Cochrane Database Syst Rev Source Type: research

Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke.
CONCLUSIONS: Treatment with a LMWH or heparinoid after acute ischaemic stroke appears to decrease the occurrence of DVT compared with standard UFH, but there are too few data to provide reliable information on their effects on other important outcomes, including functional outcome, death and intracranial haemorrhage. PMID: 28374884 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 4, 2017 Category: Journals (General) Authors: Sandercock PA, Leong TS Tags: Cochrane Database Syst Rev Source Type: research

Immediate versus delayed treatment for recently symptomatic carotid artery stenosis.
CONCLUSIONS: There is currently no high-quality evidence available to support either very early or delayed cerebral revascularization after a recent ischemic stroke. Hence, further randomized trials to identify which patients should undergo very urgent revascularization are needed. Future studies should stratify participants by age group, sex, grade of ischemia, and degree of stenosis. Currently, there is one ongoing RCT that is examining the timing of cerebral revascularization. PMID: 27611108 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 8, 2016 Category: Journals (General) Authors: Vasconcelos V, Cassola N, da Silva EM, Baptista-Silva JC Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for stroke rehabilitation.
CONCLUSIONS: From the available evidence, acupuncture may have beneficial effects on improving dependency, global neurological deficiency, and some specific neurological impairments for people with stroke in the convalescent stage, with no obvious serious adverse events. However, most included trials were of inadequate quality and size. There is, therefore, inadequate evidence to draw any conclusions about its routine use. Rigorously designed, randomised, multi-centre, large sample trials of acupuncture for stroke are needed to further assess its effects. PMID: 27562656 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 25, 2016 Category: Journals (General) Authors: Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ Tags: Cochrane Database Syst Rev Source Type: research

Intraoperative mild hypothermia for postoperative neurological deficits in people with intracranial aneurysm.
CONCLUSIONS: It remains possible that intraoperative mild hypothermia could prevent death or dependency in activities of daily living in people with good grade aneurysmal subarachnoid haemorrhage. However, the confidence intervals around this estimate include the possibility of both benefit and harm. There was insufficient information to draw any conclusions about the effects of intraoperative mild hypothermia in people with poor grade aneurysmal subarachnoid haemorrhage or without subarachnoid haemorrhage. We did not identify any reliable evidence to support the routine use of intraoperative mild hypothermia. A high-quali...
Source: Cochrane Database of Systematic Reviews - March 21, 2016 Category: Journals (General) Authors: Li LR, You C, Chaudhary B Tags: Cochrane Database Syst Rev Source Type: research

Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke.
CONCLUSIONS: At the moment, evidence of very low to moderate quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance after stroke. However, there are many ongoing randomised trials that could change the quality of evidence in the future. Future studies should particularly engage those who may benefit most from tDCS after stroke and in the effects of tDCS on upper and lower limb function, muscle strength and cognitive abilities (including spatial neglect). Dropouts and adverse events should be routinely monitored and presented as sec...
Source: Cochrane Database of Systematic Reviews - March 20, 2016 Category: Journals (General) Authors: Elsner B, Kugler J, Pohl M, Mehrholz J Tags: Cochrane Database Syst Rev Source Type: research

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