Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
Medicina (Kaunas). 2023 Feb 24;59(3):453. doi: 10.3390/medicina59030453.
Current primary intracerebral hemorrhage (ICH) treatments focus on limiting hematoma volume by lowering blood pressure, reversing anticoagulation, or hematoma evacuation. Nevertheless, there is no effective strategy to protect the brain from secondary injury due to ICH. Excess heme and iron as by-products of lysing clots in ICH might contribute to this secondary injury by triggering perihematomal edema. We present a clinical situation of an ICH case where iron-chelating therapy might be beneficial, as supported by scientific evidence. We looked through four databases (Pubmed, Cochrane, Embase, and Google Scholar) to find studies assessing the efficacy of iron-chelating therapy in ICH patients. Validity, importance, and applicability (VIA) of the included articles were appraised using worksheets from the Oxford Centre for Evidence-Based Medicine. Two out of five eligible studies were valid, important, and applicable to our patient. Both studies showed the positive effects of iron-chelating therapy on neurological outcome, as measured by National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Score (mRS). The beneficial effects of deferoxamine were demonstrated within the moderate volume (10-30 mL) subgroup, with a positive relative risk reduction (RRR) and low number needed to treat (six persons). Based on our appraisal, we considered iron-chelating therapy as an additional therapy for ICH patients, given its benefits and adverse effects. More specific studies using a larger sample size, focusing on moderate-volume ICH, and using standardized neurological outcomes are encouraged.
目前原发性脑出血 (ICH) 的治疗方法主要集中在通过降低血压、逆转抗凝或血肿清除来限制血肿量。然而，目前尚无有效的策略来保护大脑免受 ICH 引起的继发性损伤。ICH 中血栓溶解产生的多余血红素和铁作为副产物，可能通过引发血肿周围水肿而导致继发性损伤。我们提出了一个 ICH 病例的临床情况，铁螯合治疗可能是有益的，这得到了科学证据的支持。我们通过四个数据库（Pubmed、Cochrane、Embase 和 Google Scholar）查找评估 ICH 患者铁螯合治疗疗效的研究。使用牛津循证医学中心的工作表评估纳入文章的有效性、重要性和适用性（VIA）。五项合格研究中有两项是有效的、重要的和适用于我们的患者。这两项研究均表明铁螯合治疗对神经功能结局有积极影响，如 NIH 卒中量表 (NIHSS) 评分和改良 Rankin 量表 (mRS) 所测量的。在中等体积（10-30ml）亚组中，去铁胺的有益效果得到了证实，具有阳性相对风险降低 (RRR) 和低需要治疗人数（6 人）。基于我们的评估，我们认为铁螯合治疗是 ICH 患者的一种额外治疗方法，因为它有获益也有不良反应。鼓励开展使用更大样本量、关注中等体积 ICH 并使用标准化神经结局的更具体研究。
