Golden Hour Intravenous Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

IF 8.1 1区医学 Q1 CLINICAL NEUROLOGY

Annals of Neurology Pub Date : 2024-06-25 DOI:10.1002/ana.27007

Fahad S. Al-Ajlan MD, Ahmed Alkhiri MBBS, Aser F. Alamri MBBS, Basil A. Alghamdi MBBS, Ahmed A. Almaghrabi MBBS, Abdullah R. Alharbi MBBS, Nayef Alansari MBBS, Ahmed Z. Almilibari MBBS, M. Shazam Hussain MD, Heinrich J. Audebert MD, James C. Grotta MD, Ashfaq Shuaib MD, Jeffrey L. Saver MD, Adel Alhazzani MD

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引用次数: 0

Abstract

Objectives

The benefits of intravenous thrombolysis are time-dependent, with maximum efficacy when administered within the first “golden” hour after onset. Nevertheless, the impact of golden hour thrombolysis has not been well quantified.

Methods

Medline, Embase, and Web of Science databases were systematically searched from inception to August 27, 2023. We included studies that reported safety and efficacy outcomes of ischemic stroke patients treated with intravenous thrombolysis in the golden hour versus later treatment window. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0–1 at 90 days. The secondary efficacy outcome was a good functional outcome (defined as modified Rankin Scale score of 0–2). The main safety outcome was symptomatic intracerebral hemorrhage.

Results

Seven studies involving 78,826 patients met the selection criteria. Golden hour thrombolysis was associated with higher odds of 90-day excellent functional outcomes (OR 1.40, 95% CI 1.16–1.67) and 90-day good functional outcomes (OR 1.38, 95% CI 1.13–1.69) compared with thrombolysis outside the golden hour. The number needed to treat to benefit for golden hour thrombolysis to reduce disability by at least 1 level on the modified Rankin Scale per patient was 2.6. Rates of symptomatic intracerebral hemorrhage and mortality were similar between groups.

Interpretation

Golden hour thrombolysis significantly improved acute ischemic stroke outcomes. The findings provide rationale for intensive efforts aimed at expediting thrombolytic therapy within the golden hour window following the onset of acute ischemic stroke. ANN NEUROL 2024;96:582–590

查看原文本刊更多论文

急性缺血性脑卒中的 "黄金时间 "静脉溶栓治疗：系统综述与元分析》。

目的：静脉溶栓的疗效与时间有关，在发病后的第一个 "黄金 "小时内进行溶栓疗效最佳。然而，"黄金 "一小时溶栓的影响尚未得到很好的量化：我们对 Medline、Embase 和 Web of Science 数据库进行了系统检索，检索时间从开始到 2023 年 8 月 27 日。我们纳入了报告缺血性脑卒中患者在黄金时间内接受静脉溶栓治疗的安全性和有效性结果的研究。主要疗效结果是极佳的功能预后，即 90 天时修正的 Rankin 量表评分为 0-1。次要疗效结果是良好的功能结果（定义为修改后的 Rankin 量表评分为 0-2）。主要安全性结果为无症状性脑出血：有7项研究符合筛选标准，涉及78826名患者。与黄金时间外的溶栓相比，黄金时间内的溶栓与更高的90天卓越功能预后（OR 1.40，95% CI 1.16-1.67）和90天良好功能预后（OR 1.38，95% CI 1.13-1.69）相关。黄金时间内溶栓治疗使每名患者的残疾程度在改良Rankin量表上至少降低一级所需的治疗人数为2.6人。两组患者的无症状脑出血率和死亡率相似：黄金一小时溶栓治疗可明显改善急性缺血性中风的预后。这些研究结果为在急性缺血性中风发病后的黄金一小时内加快溶栓治疗提供了理论依据。ann neurol 2024.

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.