Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis.

Abstract

BACKGROUND AND PURPOSE:

Pending the results of randomized controlled trials, the benefit and safety of bridging therapy (combined intravenous and intra-arterial thrombolysis) remain to be determined. The aim of this analysis was to give reliable estimates of efficacy and safety outcomes of bridging therapy.

METHODS:

We conducted a systematic review of all studies using bridging therapy published between January 1966 and March 2011.

RESULTS:

The literature search identified 15 studies. The pooled estimate for recanalization rate was 69.6% (95% CI, 63.9%-75.0%). Meta-analysis on clinical outcomes showed a pooled estimate of 48.9% (95% CI, 42.9%-54.9%) for favorable outcome, 17.9% (95% CI, 12.7%-23.7%) for mortality, and 8.6% (95% CI, 6.8%-10.6%) for symptomatic intracranial hemorrhage. In meta-regression analysis, the shorter mean time to intravenous treatment, the greater the recanalization rate (per 10-minute decrease: OR, 1.24; 95% CI, 1.02-1.51) and the lower mortality rate (per 10-minute decrease: OR, 0.75; 95% CI, 0.60-0.94). By using the control groups of intravenous alteplase-treated patients in 8 studies, bridging therapy was associated with a favorable outcome (OR, 2.26; 95% CI, 1.16-4.40), but no differences in mortality or symptomatic intracranial hemorrhage outcomes were found.

CONCLUSIONS:

Bridging therapy is associated with acceptable safety and efficacy in stroke patients. Time to intravenous treatment is critical to improve recanalization rates and favorable outcomes.

• Authors: Mikael Mazighi, Elena Meseguer, Julien Labreuche, Pierre Amarenco
• Journal: Stroke (Stroke) Vol. 43 Issue 5 Pg. 1302-8 (May 2012) ISSN: 1524-4628 [Electronic] United States
• PMID: 22529310 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)

Chemical References

• Fibrinolytic Agents
• Tissue Plasminogen Activator

Topics

• Fibrinolytic Agents (administration & dosage, adverse effects, therapeutic use)
• Humans
• Infusions, Intra-Arterial
• Infusions, Intravenous
• Stroke (drug therapy, mortality)
• Survival Rate
• Thrombolytic Therapy (adverse effects, methods)
• Tissue Plasminogen Activator (administration & dosage, adverse effects, therapeutic use)
• Treatment Outcome