Stroke: fibrinogen depleting agents had no clear effect on death or disability.

Clinical bottom line (level 1a-)

  1. Patients with acute ischaemic stroke who were given fibrinogen depleting agents had no clear difference in death or disability, than those given a control.
  2. Patients who were given fibrinogen depleting agents had no clear difference in intracranial haemorrhage, than those given a control.
Liu et al: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of randomised and quasi-randomised controlled trials of
  • Patients: presumed or definite acute ischaemic stroke
  • Intervention: fibrinogen depleting agents within 14 days of stroke compared with control
  • Outcome: death or disability and intracranial haemorrhage


    • Articles found in ?language using Cochrane Stroke Group trials register, EMBASE and the Index of Scientific and Technical Proceedings (1982-19960, dates unstated (search terms: ancrod, batroxobin, defibrinogen, snake venom and defibrase AND stroke or cerebrovasc* ) and Handsearched ten Chinese journals and the proceedings of the 4th Chinese Stroke Conference (1995) and contacted Chinese and Japanese researchers and drug companies.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: use of another active treatment as well as fibrinogen depleting agent or transient ischaemic attacks only.

    Three trials involving 182 patients were included.
    There was no statistically significant heterogeneity.

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death or disability unknown 44
    (64.7%)    		 31
    (48.4%)    		 25.0%
    (-2.00% to 45.0%)    		 16.3%
    (-0.43% to 33.0%)    		 6
    (NNT = 3 to infinity;
    NNH = 231 to infinity)
    intracranial haemorrhage unknown 8
    (9.64%)    		 6
    (7.59%)    		 21.0%
    (-117% to 71.0%)    		 2.04%
    (-6.58% to 10.7%)    		 49
    (NNT = 9 to infinity;
    NNH = 15 to infinity)

    Citation

    1. Liu M, Counsell C, Wardlaw J: Fibrinogen depleting agents for acute ischaemic stroke. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient acute ischaemic stroke
    Intervention or Exposure fibrinogen depleting agents
    Comparison control
    Outcome death or disability