Fibrinolytics-facilitated chronic subdural haematoma drainage - a systematic review.

Abstract

BACKGROUND\nThe current treatment options of chronic subdural haematoma (CSDH) include burr hole drainage (BHD), twist drill drainage (TD) and craniotomy with or without post-operative catheter drainage. Though generally effective, these treatments continue to be complicated by recurrence, especially in partially haemolysed or septated haematomas. Recently, there has been an increasing interest in using fibrinolytics as an adjunct to surgical treatment to address this limitation. We conducted a systematic review, focusing on the efficacy and safety profile of fibrinolytics and the comparison between different fibrinolytic agents.\n\n\nMETHODS\nPubMed, EMBASE, CINAHL Plus and Cochrane library were searched for trials relevant to fibrinolytics administration in the treatment of CSDH. Findings were reported according to the PRISMA guideline. A total of 1702 subjects from 6 retrospective observational studies were qualitatively analysed. Eleven case series and reports were also included for discussion.\n\n\nRESULTS\nIn a total of 1449 patients, the use of urokinase or tissue plasminogen activator (tPA) improved haematoma drainage and shortened hospital stay (7.04 days), with an overall haematoma recurrence rate of 1.59%. The incidences of infection, seizure and intracranial bleeding were 3.18%, 0.80% and 0.41%, respectively, which compared favourably with previously reported findings with surgical drainage without fibrinolytics.\n\n\nCONCLUSIONS\nThe routine use of intrathecal urokinase and tPA could be a new direction in the management of CSDH. Conclusive clinical evidence is lacking, however, and further prospective controlled studies are warranted to confirm the benefit and safety of this treatment strategy and to identify the optimal agent and dosing regimen.