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Evidence summaries

Corticosteroids for Acute Ischaemic Stroke

Corticosteroids are probably not effective in the treatment of acute presumed ischaemic stroke. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 8 studies with a total of 466 patients with acute presumed ischaemic stroke. Few patients had the diagnosis of ischaemic stroke confirmed by a CT scan. Six trials used dexamethasone and two used betamethasone. No difference was shown in the odds of death within one year (OR 0.87, 95% CI 0.57 to 1.34). Treatment did not appear to improve functional outcome in survivors. Seven trials reported neurological impairment but pooling the data was impossible because no common scale or time interval was used. The results were inconsistent between individual trials. The only adverse effects reported were small numbers of gastrointestinal bleeds, infections and deterioration of hyperglycaemia across both groups.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals, few outcome events) and indirectness (differences between the population of interest and those studied).

    References

    • Sandercock PA, Soane T. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev 2011;9:CD000064. [PubMed]

Primary/Secondary Keywords