Intravenous thrombolysis for acute ischemic stroke in the extended time window of 4.5–24 h: a systematic review and network meta-analysis of randomized controlled trials - Report - MDSpire
Advertisement
Intravenous thrombolysis for acute ischemic stroke in the extended time window of 4.5–24 h: a systematic review and network meta-analysis of randomized controlled trials
Clinical Report: Evaluation of Intravenous Thrombolytic Therapy for Acute Ischemic Stroke
Overview
This systematic review and network meta-analysis evaluated the efficacy and safety of intravenous thrombolytic agents for acute ischemic stroke within 4.5 to 24 hours of symptom onset. Results indicated that rt-PA significantly improves functional independence at 90 days but increases the risk of symptomatic intracranial hemorrhage.
Background
Acute ischemic stroke (IS) is a leading cause of morbidity and mortality worldwide, accounting for a significant proportion of stroke cases. The timely administration of thrombolytic therapy is critical for improving patient outcomes, yet the efficacy and safety of these treatments within an extended time window remain unclear. This study aims to inform clinical decision-making and update guidelines regarding thrombolytic therapy in this context.
Data Highlights
Intervention
90-day mRS 0–2
24-h Reperfusion
36-h SICH
rt-PA
RR = 1.21 (95% CI 1.06–1.38)
RR = 2.65 (95% CI 1.57–4.46)
RR = 5.82 (95% CI 1.47–22.95)
JX10
RR = 1.50 (95% CI 0.87–2.58)
-
-
TNK
RR = 1.07 (95% CI 0.93–1.23)
-
-
SoC
-
-
-
PBO
-
-
-
Key Findings
rt-PA significantly increased the proportion of patients achieving mRS 0–2 at 90 days compared to standard of care (RR = 1.21).
JX10 showed a trend toward improvement in functional independence but did not reach statistical significance.
rt-PA was superior to standard of care for 24-h reperfusion (RR = 2.65).
rt-PA significantly increased the risk of symptomatic intracranial hemorrhage compared to standard of care (RR = 5.82).
No statistically significant differences in 90-day mortality rates among the interventions were observed.
The certainty of evidence was predominantly low to very low due to risk of bias and imprecision.
Clinical Implications
The findings suggest that while rt-PA can improve functional outcomes in acute ischemic stroke, it also carries a significant risk of symptomatic intracranial hemorrhage. Clinicians should weigh the benefits against the risks when considering thrombolytic therapy in patients presenting within the 4.5 to 24-hour window.
Conclusion
In conclusion, rt-PA demonstrates efficacy in improving outcomes for acute ischemic stroke within the specified time frame, but its associated risks necessitate careful patient selection and risk assessment.
