Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta-analysis.

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY

Annals of Clinical and Translational Neurology Pub Date : 2024-10-29 DOI:10.1002/acn3.52239

Omar M Al-Janabi, Seyed Behnam Jazayeri, Michelle A Toruno, Yamama M Mahmood, Sherief Ghozy, Shadi Yaghi, Alejandro A Rabinstein, David F Kallmes

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引用次数: 0

Abstract

Objective: About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of <4.5 h. This study is to elucidate the safety and efficacy of IVT in the extended therapeutic window (ETW) in patients with AIS.

Methods: Using PRISMA guidelines, a systematic review was conducted using PubMed, Embase, and Scopus. A rigorous risk of bias assessment was conducted using the RoB2 tool. Rates of excellent and good functional outcome (mRS 0-1 and mRS 0-2) at 90 days, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days were pooled using generalized linear mixed model and compared with controls. Meta-analyses were conducted employing random-effect models with risk ratio (RR) and 95% confidence intervals (CIs). Subgroup analysis was performed to assess the effect of imaging modalities used for patient selection.

Results: Eight randomized controlled trials (n = 2221, 59% male) were included. At 90 days IVT showed higher rates of functional recovery: mRS 0-1: RR 1.21 95% CI 1.1-1.34, p < 0.001, and mRS 0-2: RR 1.11 95% CI 1.03-1.18, p = 0.004. Rate of mortality at 90 day was not different between groups: RR 1.17 95% CI 0.93-1.48, p = 0.17. However, the rate of sICH was higher among IVT group: RR 2.93 95% CI 1.53-5.6, p = 0.001. Subgroup analysis showed higher mRS 0-1 among patients who were selected based on perfusion imaging (p < 0.05).

Interpretation: The use of IVT in AIS in ETW is beneficial especially with the use of perfusion imaging for patients' selection.

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静脉溶栓疗法在延长至 24 小时窗口期的安全性和有效性：系统回顾和荟萃分析。

目的约 25% 的急性缺血性卒中（AIS）患者出现在静脉溶栓（IVT）治疗窗内：根据 PRISMA 指南，使用 PubMed、Embase 和 Scopus 进行了系统性回顾。使用 RoB2 工具进行了严格的偏倚风险评估。采用广义线性混合模型对 90 天时的优秀和良好功能预后率（mRS 0-1 和 mRS 0-2）、症状性颅内出血（sICH）和 90 天时的死亡率进行了汇总，并与对照组进行了比较。采用随机效应模型和风险比（RR）及95%置信区间（CI）进行元分析。进行了分组分析，以评估用于选择患者的成像模式的影响：共纳入八项随机对照试验（n = 2221，59% 为男性）。90天后，IVT显示出更高的功能恢复率：mRS 0-1：RR 1.21 95% CI 1.1-1.34，P 解释：对 ETW 中的 AIS 使用 IVT 是有益的，尤其是在使用灌注成像对患者进行选择时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.