OBJECTIVE: To update the 2002 meta-analysis of hemodilution for acute ischemic stroke published in the Cochrane Library.BACKGROUND: As ischemic stroke disrupts perfusion to a portion of brain, the proposed mechanism of acute treatment with hemodilution is to increase perfusion through collaterals to the penumbra.METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) from 2002 to 2011. Randomized trials of hemodilution treatment initiated within 72 hours in patients with acute ischemic stroke were included. One reviewer assessed the 1,941 studies returned on CENTRAL search for trial quality and extracted data. The weighted estimate of the odds ratio was calculated using the Peto fixed-effect method.RESULTS: Since the 2002 meta-analysis, which consisted of eighteen trials, one additional study comparing hypervolemic hemodilution with albumin versus saline was included. This study was suspended early after recruiting 434 subjects due to safety concerns of increased death rate in the intervention arm. Two randomized trials were excluded as the outcomes were neurological and functional scores, which were exclusion criteria as score are difficult to compare across trials. Considering all hemodilution studies, the early (before 28 days) case fatality odds ratio was 1.12 (95% CI 0.89-1.41), the late (3-6 month) case fatality odds ratio was 1.08 (95% CI 0.91-1.28), and the serious cardiac event (myocardial infarction and acute congestive heart failure) odds ratio was 1.31 (95% CI 0.92-1.87) compared to 0.99 (95% CI 0.66-1.50) from the 2002 meta-analysis. Now with two hemodilution trials studying albumin, the late case fatality odds ratio was 1.19 (95% CI 0.81-1.74) compared to 0.76 (95% CI 0.43-1.19) from the 2002 meta-analysis.CONCLUSION: Future work includes an additional reviewer to assess trial quality and CENTRAL search up to 2013. Overall, the results of this meta-analysis were comparable to the 2002 meta-analysis with a trend suggesting the possibility of harm with hemodilution therapy.Study Supported by:NIH NCATS UL1TR000427 and NHLBI Fellowship F30HL112491.
Disclosure: Dr. Chang has nothing to disclose. Dr. Jensen has nothing to disclose.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P1.113?rss=1
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