Fibrinogen depleting agents for acute ischaemic stroke

Liu M, Counsell C, Zhao X, Wardlaw JM

Published Online:

January 21, 2009

Fibrinogen depleting agents are promising but unproven for acute ischaemic stroke. Most strokes are due to a blood clot blocking an artery in the brain. Fibrinogen depleting agents may help remove the blood clot to restore the blood supply to the brain and so improve the chance of making a recovery from the stroke. Fibrinogen depleting agents also reduce blood thickness (or viscosity) which also helps to improve blood flow to the brain. However, these agents can also cause serious bleeding in the brain. The limited trial data available suggest that fibrinogen depleting agents may improve outcome after stroke. However, the data from a recently completed trial and an ongoing trial are not yet available. No firm conclusions about the balance of risk and benefit from the agents can be made until these data are included in the review.

Abstract (click to read)

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.

Objectives:

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

Search strategy:

We searched the Cochrane Stroke Group Trials Register (last searched May 2003). In addition we searched the following electronic databases: EMBASE (1980 to October 2001), China Biological Medicine Database (CBM-disc 1981 to December 2002), Chinese Stroke Trials Register (1996 to December 2002) and Index of Scientific and Technical Proceedings (Web of Science Proceedings 1990 to October 2001). We handsearched relevant journals and contacted Chinese and Japanese researchers and drug companies.

Selection criteria:

Randomised and quasi-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 reviewers independently applied the inclusion criteria, assessed trial quality and extracted the data.

Main results:

Five trials involving 2926 patients were included. A further trial has not yet been published in full. Four trials tested ancrod and one trial tested defibrase. Allocation concealment was adequate in four trials. Fibrinogen depleting agents moderately reduced the proportion of patients who were dead or disabled at the end of follow up (relative risk (RR) 0.90, 95% confidence Interval (CI) 0.82 to 0.98, 2P = 0.02). There was no statistically significant difference in death from all causes during the scheduled treatment period (RR 0.71, 95% CI 0.44 to 1.13) and at the end of follow up (RR 0.98, 95% CI 0.78 to 1.24). There was a non-significant excess of symptomatic intracranial haemorrhages with treatment (RR 2.64, 95% CI 0.96 to 7.30, 2P = 0.06).

Authors' conclusions:

Fibrinogen depleting agents are promising. However more data, particularly ESTAT data, are needed before more reliable conclusions can be drawn.

This record should be cited as:

Liu M, Counsell C, Zhao X, Wardlaw JM. Fibrinogen depleting agents for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD000091. DOI: 10.1002/14651858.CD000091

Assessed as up to date:

May 16, 2003

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Stroke Group

Health topics:

Heart & circulation > Stroke > Ischemic stroke/TIA: treatment

Neurology > Stroke > Ischemic stroke/TIA: treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Fibrinogen depleting agents for acute ischaemic stroke

More like this

Copyright © 2012 - The Cochrane Collaboration