Stroke Alert
Meta-analysis of All Randomized Trials Supports the Benefits of Intravenous Thrombolysis for All Patients Up to 6 Hours
By Matthew E. Fink, MD,
Interim Chair and Neurologist-in-Chief, Department of Neurology and Neuroscience, Weill Cornell Medical College
Matthew Fink, MD, is a retained consultant for MAQUET.
This article originally appeared in the August 2012 issue of Neurology Alert. It was peer reviewed by M. Flint Beal, MD. Dr. Beal is Anne Parrish Titzel Professor, Department of Neurology and Neuroscience, Weill Cornell Medical Center. Dr. Beal reports no financial relationships relevant to this field of study.
Source: Wardlaw JM, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: An updated systematic review and meta-analysis. Lancet 2012;379:2364-2372.
The recently published IST-3 trial has stimulated great interest in the expanded use of intravenous thrombolysis (IV rtPA). Wardlaw and colleagues assessed all of the evidence from published randomized trials for IV rtPA in acute ischemic stroke using a meta-analysis. They searched for all randomized trials of IV rtPA given within 6 hours of onset of ischemic stroke, using prespecified outcomes at 7 days and at final follow-up.
In 12 trials that included 7012 patients, IV rtPA given within 6 hours significantly increased the odds of being alive and independent at final follow-up (46.3% vs 42.1%, OR = 1.17, 95% CI 1.06-1.29; P = 0.001). The benefit of IV rtPA was greatest in patients treated within 3 hours (40.7% vs 31.7%). However, the number of deaths within 7 days was increased in the treated group (8.9% vs 6.4%), but by the time of final follow-up, this excess was not significant. Symptomatic intracranial hemorrhage accounted for most of the early excess deaths (7.7% vs 1.8%). Patients older than 80 years of age achieved similar benefit, particularly when treated early. The preponderance of evidence supports the use of IV rtPA up to 6 hours from the onset of acute ischemic stroke.
The recently published IST-3 trial has stimulated great interest in the expanded use of intravenous thrombolysis (IV rtPA). Wardlaw and colleagues assessed all of the evidence from published randomized trials for IV rtPA in acute ischemic stroke using a meta-analysis.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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