Seventeen studies (2,872 patients, range 46 to 505; 1,380 patients received antifibrinolytic therapy) were included: 12 studies were randomised controlled trials (RCTs), three were prospective observational and two were retrospective observational studies.
Overall no significant difference was seen between antifibrinolytic therapy and control for functional outcome (five studies). No differences were seen in any of the three subgroups based on duration and type of treatment, but short-term treatment reduced the numbers of poor outcomes (29% versus 37.8%) and long-term treatment appeared to increase them. None of these results were statistically significant.
Antifibrinolytic therapy significantly reduced rates of re-bleeding compared to controls (OR 0.48, 95% CI 0.30 to 0.76; 15 studies with Ι²=72%). Similar results were seen for all three subgroups. Antifibrinolytic therapy significantly increased rates of cerebral infarction (OR 1.27, 95% CI 1.05 to 1.54; nine studies with Ι²=39%). The only subgroup showing a similar increase was long-term therapy with no medical prevention (OR 1.90, 95% CI 1.37 to 2.64; six studies with Ι²=0%).