Hemodilution for acute ischemic stroke.

schemic stroke involves focal hypoperfusion of the central nervous system. Hemodilution could theoretically improve perfusion to the affected area and, therefore, reduce infarct size. Objective To assess the effects of hemodilution on clinical outcomes in patients with acute ischemic stroke. We also searched trials registers, scanned reference lists, and contacted authors. We included random-ized trials of hemodilution treatment in acute ischemic stroke, started within 72 hours of symptom onset, and which reported clinical outcomes. Two authors assessed trial quality and 1 author extracted the data. We found 21 trials involving 4174 participants matching our selection criteria. Nine trials used a combination of venesec-tion and plasma volume expander. Twelve trials used plasma volume expander alone. The plasma volume expander was plasma alone in 1 trial, dextran 40 in 12 trials, hydroxyethyl starch in 5 trials, and albumin in 3 trials. Two trials tested hemo-dilution in combination with another therapy. Evaluation was blinded in 14 trials. Five trials probably also included some participants with intracerebral hemorrhage. Hemodilution did not significantly reduce death within the first 4 weeks (risk ratio, 1.10; 95% confidence interval, 0.90–1.34; Figure). Similarly, hemodilution did not influence death within 3 to 6 months (risk ratio, 1.05; 95% confidence interval, 0.93–1.20) or death and dependency or institutionalization (risk ratio, 0.96; 95% confidence interval, 0.85–1.07). The results were similar in confounded and unconfounded trials, and in trials of isovolemic and hypervolemic hemodilution. No statistically significant benefits were documented for any particular type of hemodiluting agents, but the statistical power to detect effects of hydroxyethyl starch was weak. Six trials reported venous thromboembolic events. There was a trend toward reduction in deep venous thrombosis, pulmonary embolism, or both at 3 to 6 months (risk ratio, 0.68; 95% confidence interval, 0.37– 1.24). There was no statistically significant increased risk of serious cardiac events among hemodiluted patients. Conclusions We did not find clear evidence of benefit of hemodilution therapy for acute ischemic stroke on clinical outcomes. This article is based on a Cochrane Review published in The Cochrane Library 2014, Issue 8 (see www.thecochraneli-brary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback , and The Cochrane Library should be consulted for the most recent version of the review.