Evidence map›Paper›PMID 25853905›Full record

Trial reportJournal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism2015

Intraventricular fibrinolysis with tissue plasminogen activator is associated with transient cerebrospinal fluid inflammation: a randomized controlled trial.

Andreas H Kramer, Craig N Jenne, David A Zygun, Derek J Roberts, Michael D Hill, Jessalyn K Holodinsky, Stephanie Todd, Paul Kubes, John H Wong

Open access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed, 3 pooled it
2.4field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 30 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Andreas H Kramer1] Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Craig N JenneThe Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.
David A Zygun1] Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada [3] Department of Medicine, University of Alberta, Edmonton, Alberta, Canada [4] Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Derek J Roberts1] Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada [3] Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Michael D Hill1] Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada [2] Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Jessalyn K HolodinskyDepartment of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Stephanie ToddDepartment of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
Paul Kubes1] Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada [2] The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada.
John H WongDepartment of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
University of Calgary · CAUniversity of Alberta · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Locally administered tissue plasminogen activator (TPA) accelerates clearance of intraventricular hemorrhage (IVH), but its impact on neurologic outcomes remains unclear and preclinical research suggests it may have pro-inflammatory effects. We randomly allocated patients with ruptured cerebral aneurysms and IVH, treated with endovascular coiling and ventricular drainage, to receive either 2-mg intraventricular TPA or placebo every 12 hours. Cerebrospinal fluid (CSF) and serum cytokine and white blood cell (WBC) concentrations were measured before drug administration and daily for 72 hours. Cerebrospinal fluid D-dimer levels were assessed 6 and 12 hours after administration to quantify fibrinolysis. Six patients were randomized to each group. Patients treated with TPA developed higher CSF cytokine concentrations compared with placebo-treated patients (P<0.05 for tumor necrosis factor-α, interferon-γ, interleukin (IL)-1α, IL-1β, IL-2, IL-4, and IL-6), as well as higher CSF WBC counts (P=0.03). Differences were greatest after 24 hours and decreased over 48 to 72 hours. The magnitude of the inflammatory response was significantly associated with peak CSF D-dimer concentration and extent of IVH clearance. We conclude that intraventricular TPA administration produces a transient local inflammatory response, the severity of which is strongly associated with the degree of fibrinolysis, suggesting it may be induced by release of hematoma breakdown products, rather than the drug itself.

Indexed as

Cerebral HemorrhageFibrinolytic AgentsIntracranial AneurysmTissue Plasminogen ActivatorAgedCytokinesFemaleFibrin Fibrinogen Degradation ProductsFibrinolysisHumansInflammationMaleMiddle AgedCytokinesFibrin Fibrinogen Degradation Productsfibrin fragment DFibrinolytic AgentsTissue Plasminogen Activator

Identifiers

PMID25853905
PMCPMC4528006
OpenAlexW1978690745

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.