Thrombolysis for aneurysmal subarachnoid haemorrhage

Area of Science:

• Neurology
• Neurosurgery
• Critical Care Medicine

Background:

• Aneurysmal subarachnoid hemorrhage (aSAH) presents a significant global health challenge, leading to substantial morbidity and mortality.
• Despite advancements in medical care, outcomes for aSAH patients remain suboptimal.
• Emerging evidence suggests local thrombolysis may offer therapeutic benefits.

Purpose of the Study:

• To evaluate the efficacy of thrombolysis in improving functional outcomes and reducing case fatality in aSAH patients.
• To determine the impact of thrombolysis on the incidence of cerebral vasospasm, delayed cerebral ischemia, and hydrocephalus.
• To assess the safety profile of local thrombolysis, specifically the risk of hemorrhagic complications.

Main Methods:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing local thrombolysis with placebo or standard care.
• Searches conducted across major databases (Cochrane, MEDLINE, Embase) and clinical trial registries.
• Risk of bias assessment using the Cochrane tool, with sensitivity analyses performed.

Main Results:

• Thrombolysis likely reduces poor functional outcomes (RR 0.73, 95% CI 0.56-0.94) and cerebral artery vasospasm (RR 0.70, 95% CI 0.54-0.91).
• Evidence suggests thrombolysis may reduce delayed cerebral ischemia (low-certainty evidence).
• No significant difference observed in case fatality, hemorrhagic complications, cerebral infarction, or hydrocephalus risk.

Conclusions:

• Local thrombolysis shows potential for improving functional outcomes and reducing vasospasm in aSAH patients.
• The treatment appears safe regarding hemorrhagic complications, though evidence is low-certainty.
• Further high-quality RCTs are necessary to confirm these findings due to current evidence limitations.