This document summarizes a presentation on the use of tissue plasminogen activator (tPA) in patients with Fisher grade IV subarachnoid hemorrhage. It describes a clinical case study of a patient and formulates a searchable question about whether tPA improves outcomes in patients with intraventricular extension of aneurysmal subarachnoid hemorrhage. It then outlines the search strategy and databases used, screening process for relevant articles, summary of identified papers in a table, and conclusions that tPA accelerates clot resolution but there is not enough evidence that it improves outcomes due to the need for larger multicenter randomized controlled trials.

1. The use tissue plasminogen activator
in Fisher grade IV SAH
Khalid Alsahli
Macquarie Neurosurgery
Evidence Based Surgery presentation
Date: 10/10/2013
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2. Clinical case
• Male, 6th decade, collapse, GCS 3
• CT – Fisher grade IV SAH. Ruptured AcomA
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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
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4. Search strategy
• Medline, Embase, Scopus
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5. Medline
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6. Medline – Mary’s edition
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7. Embase
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8. Embase
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9. Embase – Mary’s edition
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10. Scopus
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11. Search cont.
• Excluded case reports, unrelated topics.
• 7 articles were identified
• 3 were excluded – included patients with ICH
and non-aneurysmal SAH.
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12. Summary of papers
• Excel table
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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.
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