Stroke: haemodilution has no clear effect on death.

Clinical bottom line (level 1a-)

  1. Patients with acute ischaemic stroke who are treated with haemodilution have no clear difference in early (7-28 days) or late (3-6 months) death, than those given placebo.
Asplund et al: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of randomised controlled trials of
  • Patients: acute ischaemic stroke
  • Intervention: hyper- and isovolemic haemodilution within 72 hours of the onset of symptoms compared with no specific treatment or infusion of crystalloids
  • Outcome: early (7-28 days) or late (3-6 months) death


    • Articles found in ? language using Cochrane Stroke Group trials register and MEDLINE, ? dates (search terms: haemodilution, bloodletting, venesection, plasma expanders, dextran, hydroxyethyl, starch, albumin ) and searched conference abstracts and contacted manufacturers and investigators in the field.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: none given

    Fifteen studies involving 2756 patients were included.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN?
    (% CI)
    death 28 days /
    (%)    		 1.14
    (0.89 to 1.46)
    death 6 months /
    (%)    		 1.04
    (0.86 to 1.26)
    death or dependency 3-6 months /
    (%)    		 1.03
    (0.87 to 1.22)

    Comments

    1. There were no differences between hyper- and iso-volaemic haemodilution, nor between types of plasma volume expander (dextran-40, hydroxyethyl starch, albumin), nor in the subgroup with highest initial haematocrits.
    2. Some patients included could have had a haemorrhagic stroke.
    3. Unless new patho-physiological evidence emerges about likely benefits from haemodilution, either in extent, stroke sub-types or using new plasma expanding agents, there is little justification for further trials. Haemodilution is not indicated in acute ischaemic stroke.

    Citation

    1. Asplund K, Israelsson K, Schampi I: Haemodilution for acute ischaemic stroke. The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer: RH Harwood

    Clinical Question.
    Patient acute ischaemic stroke
    Intervention or Exposure haemodilution
    Comparison control
    Outcome early and late death