Chen Jiana, Zeng Zhiwei, Fang Zongwei, Ma Fuxin, Lv Meina, Zhang Jinhua
Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, China.
Thromb J. 2023 Mar 14;21(1):27. doi: 10.1186/s12959-023-00467-6.
Thrombolysis-related intracranial hemorrhage has a high mortality rate, and many factors can cause intracranial hemorrhage. Until now, systematic reviews and assessments of the certainty of the evidence have not been updated.
We conducted a systematic review to identify risk factors for thrombolysis-related intracranial hemorrhage.
The protocol for this systematic review was prospectively registered with PROSPERO (CRD42022316160). All English studies that met the inclusion criteria published before January 2022 were obtained from PubMed, EMBASE, Web of Science, and Cochrane Library. Two researchers independently screened articles, extracted data, and evaluated the quality and evidence of the included studies. Risk factors for intracranial hemorrhage were used as the outcome index of this review. Random or fixed-effect models were used in statistical methods.
Of 6083 citations, we included 105 studies in our analysis. For intracranial hemorrhage, moderate-certainty evidence showed a probable association with age, National Institutes of Health stroke scale, leukoaraiosis, hypertension, atrial fibrillation, diabetes, total cholesterol, proteinuria, fibrinogen levels, creatinine, homocysteine, early infarct signs, antiplatelet therapy and anticoagulant therapy; In addition, we found low-certainty evidence that there may be little to no association between risk of intracranial hemorrhage and weight, sex, platelet count, uric acid, albumin and white matter hyperintensity. Leukoaraiosis, cardiovascular disease, total cholesterol, white blood cell count, proteinuria, fibrinogen levels, creatinine, homocysteine and early CT hypodensities are not included in most intracranial hemorrhage risk assessment models.
This study informs risk prediction for thrombolysis-related intracranial hemorrhage, it also informs guidelines for intracranial hemorrhage prevention and future research.
溶栓相关颅内出血死亡率高，多种因素可导致颅内出血。迄今为止，证据确定性的系统评价和评估尚未更新。
我们进行了一项系统评价，以确定溶栓相关颅内出血的危险因素。
本系统评价方案已在PROSPERO（CRD42022316160）上进行前瞻性注册。从PubMed、EMBASE、Web of Science和Cochrane图书馆获取了2022年1月前发表的所有符合纳入标准的英文研究。两名研究人员独立筛选文章、提取数据，并评估纳入研究的质量和证据。颅内出血的危险因素用作本评价的结局指标。统计方法采用随机或固定效应模型。
在6083条引文中，我们纳入了105项研究进行分析。对于颅内出血，中等确定性证据表明与年龄、美国国立卫生研究院卒中量表、脑白质疏松症、高血压、心房颤动、糖尿病、总胆固醇、蛋白尿、纤维蛋白原水平、肌酐、同型半胱氨酸、早期梗死征象、抗血小板治疗和抗凝治疗可能相关；此外，我们发现低确定性证据表明颅内出血风险与体重、性别、血小板计数、尿酸、白蛋白和白质高信号之间可能几乎没有关联。脑白质疏松症、心血管疾病、总胆固醇、白细胞计数、蛋白尿、纤维蛋白原水平、肌酐、同型半胱氨酸和早期CT低密度影未纳入大多数颅内出血风险评估模型。
本研究为溶栓相关颅内出血的风险预测提供了信息，也为颅内出血预防指南和未来研究提供了信息。
