Fibrinolytic Therapy with Lumbar Drainage versus Lumbar Drainage Alone in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Proportions

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A systematic review and single-arm meta-analysis of proportions comparing fibrinolytic therapy administered through a lumbar drain (fibrinolytic lumbar drainage, FLD) with lumbar drainage alone (control lumbar drainage, CLD) in adults with aneurysmal subarachnoid hemorrhage. Pooled rates of symptomatic vasospasm, delayed cerebral infarction, favorable functional outcome, mortality, and shunt-dependent hydrocephalus were estimated for each strategy, with an exploratory within-study comparison. The review incorporates a single-center case series contributed by the authors within the FLD group. Note: this review was completed before registration and is registered retrospectively. PROSPERO does not accept registrations for completed reviews, and the work was previously submitted to journals that did not require prospective registration; it is therefore registered here on OSF to provide a transparent, timestamped, citable record.

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