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Thrombolytic therapy for pulmonary embolism.
CONCLUSIONS: There is low quality evidence that thrombolytics reduce death following acute pulmonary embolism compared with heparin. Furthermore, thrombolytic therapies included in the review were heterogeneous. Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause more major and minor haemorrhagic events and stroke. More high quality double blind RCTs assessing safety and cost-effectiveness are required. PMID: 26419832 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 30, 2015 Category: Journals (General) Authors: Hao Q, Dong BR, Yue J, Wu T, Liu GJ Tags: Cochrane Database Syst Rev Source Type: research

Parenteral fluid regimens for improving functional outcome in people with acute stroke.
CONCLUSIONS: We found no evidence that colloids were associated with lower odds of death or dependence in the medium term after stroke compared with crystalloids, though colloids were associated with greater odds of pulmonary oedema. We found no evidence to guide the best volume, duration, or mode of parenteral fluid delivery for people with acute stroke. PMID: 26329401 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 1, 2015 Category: Journals (General) Authors: Visvanathan A, Dennis M, Whiteley W 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 reduces morbidity. 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: 25634560 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - February 3, 2015 Category: Journals (General) Authors: Hsu CC, Kwan GN, Thompson SA, Evans-Barns H, van Driel ML Tags: Cochrane Database Syst Rev Source Type: research

Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.
CONCLUSIONS: Although we have not found conclusive evidence that etomidate increases mortality or healthcare resource utilization in critically ill patients, it does seem to increase the risk of adrenal gland dysfunction and multi-organ system dysfunction by a small amount. The clinical significance of this finding is unknown. This evidence is judged to be of moderate quality, owing mainly to significant attrition bias in some of the smaller studies, and new research may influence the outcomes of our review. The applicability of these data may be limited by the fact that 42% of the patients in our review were intubated for...
Source: Cochrane Database of Systematic Reviews - January 8, 2015 Category: Journals (General) Authors: Bruder EA, Ball IM, Ridi S, Pickett W, Hohl C 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

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

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

Antiepileptic drugs for the primary and secondary prevention of seizures after stroke.
CONCLUSIONS: Currently, there is insufficient evidence to support the routine use of antiepileptic drugs for the primary or secondary prevention of seizures after stroke. Further well-conducted research is needed for this important clinical problem. PMID: 24464793 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - February 3, 2014 Category: Journals (General) Authors: Sykes L, Wood E, Kwan J Tags: Cochrane Database Syst Rev Source Type: research

Fibrinolytic agents for peripheral arterial occlusion.
CONCLUSIONS: There is some evidence to suggest that intra-arterial rt-PA is more effective than intra-arterial streptokinase or intravenous rt-PA in improving vessel patency in people with peripheral arterial occlusion. There was no evidence that rt-PA was more effective than urokinase for patients with peripheral arterial occlusion and some evidence that initial lysis may be more rapid with rt-PA, depending on the regime. Incidences of haemorrhagic complications were not statistically significantly greater with rt-PA than with other regimes. However, all of the findings come from small studies and a general paucity of res...
Source: Cochrane Database of Systematic Reviews - December 19, 2013 Category: Journals (General) Authors: Robertson I, Kessel DO, Berridge DC Tags: Cochrane Database Syst Rev Source Type: research

Local versus general anaesthesia for carotid endarterectomy.
CONCLUSIONS: The proportion of patients who had a stroke or died within 30 days of surgery did not differ significantly between the two types of anaesthetic techniques used during carotid endarterectomy. This systematic review provides evidence to suggest that patients and surgeons can choose either anaesthetic technique, depending on the clinical situation and their own preferences. PMID: 24353155 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 19, 2013 Category: Journals (General) Authors: Vaniyapong T, Chongruksut W, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters.
CONCLUSIONS: We found no significant effects of systemic treatments compared with no intervention in preventing (a)symptomatic VTE in paediatric oncology patients with CVCs. However, this could be a result of the low number of included participants, which resulted in low power. In one CCT, which compared one systemic treatment with another systemic treatment, we identified a significant reduction in symptomatic VTE with the addition of LMWH to AT supplementation.All studies investigated the prevalence of major and/or minor bleeding episodes, and none found a significant difference between study groups. None of the studies ...
Source: Cochrane Database of Systematic Reviews - September 11, 2013 Category: Journals (General) Authors: Schoot RA, Kremer LC, van de Wetering MD, van Ommen CH Tags: Cochrane Database Syst Rev Source Type: research

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