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Meta-Analysis
. 2012 Mar 14;2012(3):CD000091.
doi: 10.1002/14651858.CD000091.pub2.

Fibrinogen depleting agents for acute ischaemic stroke

Zilong Hao  1 , Ming Liu, Carl Counsell, Joanna M Wardlaw, Sen Lin, Xiaoling Zhao
Affiliations
Meta-Analysis

Fibrinogen depleting agents for acute ischaemic stroke

Zilong Hao et al. Cochrane Database Syst Rev. .

Abstract

Background: Fibrinogen depleting agents reduce fibrinogen in blood plasma, reduce blood viscosity and hence increase blood flow. This may help remove the blood clot blocking the artery and re-establish blood flow to the affected area of the brain after an ischaemic stroke. The risk of haemorrhage may be less than with thrombolytic agents. This is an update of a Cochrane review first published in 1997 and last updated in 2003.

Objectives: To assess the effect of fibrinogen depleting agents in patients with acute ischaemic stroke.

Search methods: We searched the Cochrane Stroke Group Trials Register (July 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 7), the Chinese Stroke Trials Register (September 2011), MEDLINE (1950 to July 2011), EMBASE (1980 to July 2011) and Web of Science Conference Proceedings (1990 to July 2011). In addition, we searched six Chinese databases, four ongoing trials registers (July 2011) and relevant reference lists. For previous versions of the review, we handsearched journals and contacted researchers in China and Japan and relevant drug companies.

Selection criteria: Randomised trials of fibrinogen depleting agents started within 14 days of stroke onset, compared with control in patients with definite or possible ischaemic stroke.

Data collection and analysis: Two review authors independently selected trials, assessed trial quality and extracted the data. We resolved disagreement by discussion.

Main results: We included eight trials involving 5701 patients. Six trials tested ancrod and two trials tested defibrase (patients were treated for less than three hours to less than 48 hours). Allocation concealment was adequate in seven trials. Fibrinogen depleting agents marginally reduced the proportion of patients who were dead or disabled at the end of follow-up (risk ratio (RR) 0.95, 95% confidence Interval (CI) 0.90 to 0.99, 2P = 0.02). There was no statistically significant difference in death from all causes during the scheduled treatment or follow-up period. There were fewer stroke recurrences in the treatment group than in the control group (RR 0.67, 95% CI 0.49 to 0.92, 2P = 0.01). However, symptomatic intracranial haemorrhage was about twice as common in the treatment group compared with the control group (RR 2.42, 95% CI 1.65 to 3.56, 2P < 0.00001).

Authors' conclusions: The current evidence is promising but not yet sufficiently robust to support the routine use of fibrinogen depleting agents for the treatment of acute ischaemic stroke. Further trials are needed to determine whether there is worthwhile benefit, and if so, which categories of patients are most likely to benefit.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 1 Death or dependency at the end of follow‐up.
1.2
1.2. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 2 Death from all causes at end of treatment period.
1.3
1.3. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 3 Death from all causes at end of follow‐up.
1.4
1.4. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 4 Any symptomatic intracranial haemorrhage at end of treatment period.
1.5
1.5. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 5 Any symptomatic intracranial haemorrhage at end of follow‐up.
1.6
1.6. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 6 Any intracranial haemorrhage detected on systematic repeat CT during treatment period.
1.7
1.7. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 7 Recurrent stroke (ischaemic/unknown type) at end of treatment period.
1.8
1.8. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 8 Recurrent stroke (ischaemic/unknown type) at end of follow‐up.
1.9
1.9. Analysis
Comparison 1 Fibrinogen depleting agents versus control, Outcome 9 Venous thrombotic events.
2.1
2.1. Analysis
Comparison 2 Different agents, Outcome 1 Death or dependency at the end of follow‐up.
2.2
2.2. Analysis
Comparison 2 Different agents, Outcome 2 Death from all causes at the end of follow‐up.
2.3
2.3. Analysis
Comparison 2 Different agents, Outcome 3 Any symptomatic intracranial haemorrhage at the end of treatment period.
2.4
2.4. Analysis
Comparison 2 Different agents, Outcome 4 Recurrent stroke (ischaemic/unknown type) at the end of follow‐up.
3.1
3.1. Analysis
Comparison 3 Different treatment time from onset, Outcome 1 Death or dependency at the end of follow‐up.
3.2
3.2. Analysis
Comparison 3 Different treatment time from onset, Outcome 2 Death from all causes at end of follow‐up.
3.3
3.3. Analysis
Comparison 3 Different treatment time from onset, Outcome 3 Any intracranial haemorrhage detected on systematic repeat CT during treatment period.
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Update of

References

References to studies included in this review

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References to studies awaiting assessment

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