T pa in sah

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  • T pa in sah

    1. 1. The use tissue plasminogen activator in Fisher grade IV SAH Khalid Alsahli Macquarie Neurosurgery Evidence Based Surgery presentation Date: 10/10/2013 EBS presentation 1
    2. 2. Clinical case • Male, 6th decade, collapse, GCS 3 • CT – Fisher grade IV SAH. Ruptured AcomA EBS presentation 2
    3. 3. Searchable question (PICO format) • In patients with intraventricular extension of aneurysmal subarachnoid haemorrhage, Does the use intraventricular tPA improve outcomes? • • • • P: Patients with intraventricular extension of aneurysmal subarachnoid haemorrhage. I: Intraventricular tPA. C: O: Treatment outcomes EBS presentation 3
    4. 4. Search strategy • Medline, Embase, Scopus EBS presentation 4
    5. 5. Medline EBS presentation 5
    6. 6. Medline – Mary’s edition EBS presentation 6
    7. 7. Embase EBS presentation 7
    8. 8. Embase EBS presentation 8
    9. 9. Embase – Mary’s edition EBS presentation 9
    10. 10. Scopus EBS presentation 10
    11. 11. Search cont. • Excluded case reports, unrelated topics. • 7 articles were identified • 3 were excluded – included patients with ICH and non-aneurysmal SAH. EBS presentation 11
    12. 12. Summary of papers • Excel table EBS presentation 12
    13. 13. Conclusions • tPA accelerates intraventricular clot resolution. • Not enough evidence to support its usage to improve outcomes. • Few studies, need multicenter RCTs studies with larger sample size. EBS presentation 13

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