Abstract | BACKGROUND AND PURPOSE: METHODS: A literature search in Medline, Embase, and the Cochrane database identified case series, observational studies, and treatment arms of randomized trials of anterior circulation arterial occlusion treated with thrombolytic therapy. Included studies had ≥10 subjects, mean time to treatment <6 hours, and treatment specific reporting of disability, death, and intracerebral hemorrhage. Multivariable metaregression evaluated the effects of treatment group on outcome at the same time as accounting for differences in baseline covariates. RESULTS: A total of 2986 abstracts were identified from which 54 studies (5019 subjects) were included. There were significant differences across groups in age (P=0.0008), baseline National Institutes of Health Stroke Scale (P=0.0002), and time to treatment initiation (P<0.0001). There were also differences in mean modified Rankin Scale (P<0.0001), mortality (P=0.0024), and symptomatic intracerebral hemorrhage (P=0.0305). Differences in modified Rankin Scale were not significant in the metaregression and likely attributable to differences in baseline covariates between studies. CONCLUSIONS: This study found no evidence that one reperfusion strategy is superior with respect to efficacy or safety, supporting clinical equipoise between reperfusion strategies. Intravenous tissue-type plasminogen activator remains the standard of care for acute ischemic stroke. Randomized clinical trials are necessary to determine the efficacy of alternative reperfusion strategies. Participation in such trials is strongly recommended.
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Authors | Michael T Mullen, Jared M Pisapia, Shiv Tilwa, Steven R Messé, Sherman C Stein |
Journal | Stroke
(Stroke)
Vol. 43
Issue 9
Pg. 2350-5
(Sep 2012)
ISSN: 1524-4628 [Electronic] United States |
PMID | 22811451
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Chemical References |
- Fibrinolytic Agents
- Tissue Plasminogen Activator
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Topics |
- Aged
- Brain Ischemia
(therapy)
- Cerebral Hemorrhage
(etiology)
- Data Interpretation, Statistical
- Disability Evaluation
- Female
- Fibrinolytic Agents
(administration & dosage, adverse effects, therapeutic use)
- Humans
- Infarction, Anterior Cerebral Artery
(therapy)
- Injections, Intra-Arterial
- Injections, Intravenous
- Male
- Middle Aged
- Randomized Controlled Trials as Topic
- Regression Analysis
- Reperfusion
- Stroke
(therapy)
- Thrombolytic Therapy
(adverse effects, methods)
- Tissue Plasminogen Activator
(administration & dosage, adverse effects, therapeutic use)
- Treatment Outcome
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