Clinical efficacy and safety of hypernormal shortened door to needle time (DNT) plus individualized low-dose alteplase therapy in treating acute ischemic stroke
Abstract:Objective:This study aims to observe the clinical efficacies of hyper-early low-dose alteplase thrombolysis in treating acute ischemic stroke (AIS).Methods:Two hundred twenty AIS patients were randomly divided into group A (90 cases), group B (90 cases), and group C (40 cases). The National Institutes of Health Stroke Scale (NIHSS) scores, mRS score-evaluated prognosis, intracranial hemorrhage, and mortality of the three groups were observed before and after the treatment.Results:The NIHSS scores of the three … Show more
“…The cut-off points of rt-PA dose and groups that participants were divided into were various across included studies. There was a significant between-group difference in gender in 5 studies 22 , 23 , 25 , 27 , 29 , age in 3 studies 18 , 24 , 30 , time interval from stroke onset to IVT in 2 studies 21 , 24 , and baseline NIHSS score in 1 study 30 . One study had no significant differences in baseline information between the groups being compared 19 .…”
Section: Resultsmentioning
confidence: 98%
“…Of the remaining 18 studies, 7 were excluded (1 for focusing on patients with only mild stroke 47 , 1 for only including 2 patients who received low dose rt-PA 48 , 2 for having unavailable data even after contacting the author 49 , 50 , and 3 for using the data that were completely included in another one with a larger sample size 17 , 19 , 20 , 24 , 28 ). Eleven studies were included in the final meta-analysis 18 , 19 , 21 – 27 , 29 , 30 . Figure 1 Flow diagram of literature search and selection.…”
Section: Resultsmentioning
confidence: 99%
“…In 3 other studies, SICH was identified per author-defined criteria 22 , 29 , 30 , which was nearly the same as the ECASS II definition. One study had zero cases of intracerebral hemorrhage occur 21 . Thus, pooled analyses for SICH were conducted separately based on ECASS (ECASS II, ECASS III, and author-defined criteria), SITS-MOST, and NINDS (Table 1 , Fig.…”
Section: Resultsmentioning
confidence: 99%
“…of standard dose P hetero I 2 Fixed OR (95% CI) Random OR (95% CI) Favorable outcome 11 6076 1230/2842 1587/3594 0.01 57.2% 0.91 (0.82–1.01) 0.94 (0.77–1.15) Mortality 11 6241 250/2951 370/3650 0.89 0 0.93 (0.78–1.11) 0.93 (0.78–1.12) SICH by ECASS 9 6206 134/2713 180/3493 0.037 51.3% 1.01 (0.80–1.27) 0.93 (0.67–1.57) SICH by NINDS 6 4416 123/2054 163/2362 0.51 0 0.79 (0.61–1.01) 0.79 (0.61–1.01) SICH by SITS-MOST 4 4228 33/1936 43/2292 0.05 61.3% 0.90 (0.56–1.44) 1.12 (0.48–2.57) ECASS, the European Cooperative Acute Stroke Study (including ECASS II, ECASS III, and author-defined criteria which were nearly the same as the ECASS II definition); NINDS, the National Institute of Neurological Disorders and Stroke study; SITS-MPST, the Safe Implementation of Thrombolysis in Stroke-Monitoring study. References of included studies 18 , 19 *, 21 – 27 , 29 , 30 . *Non-Asian patients in Anderson’s study (ref.…”
Section: Resultsmentioning
confidence: 99%
“… ECASS, the European Cooperative Acute Stroke Study (including ECASS II, ECASS III, and author-defined criteria which were nearly the same as the ECASS II definition); NINDS, the National Institute of Neurological Disorders and Stroke study; SITS-MPST, the Safe Implementation of Thrombolysis in Stroke-Monitoring study. References of included studies 18 , 19 *, 21 – 27 , 29 , 30 . *Non-Asian patients in Anderson’s study (ref.…”
Whether low dose alteplase is comparable to standard dose in efficacy and safety for intravenous thrombolysis (IVT) in Asian stroke patients remains unverified. PubMed, EMBASE, and Cochrane Library Database from the beginning to June 30, 2017 were searched. IVT efficacy was measured by favorable outcome (modified Rankin Scale scores of 0–1) at 3 months, and safety measured by mortality within 3 months and symptomatic intracerebral hemorrhage (SICH). Pooled estimates were conducted using fixed- or random-effects model depending on heterogeneity. For SICH, studies were pooled separately according to different definitions. Twelve studies involving 7,905 participants were included. No association was found between alteplase dose and favorable outcome (OR = 0.94, 95% CI 0.78–1.14, P = 0.5; heterogeneity: P
hetero = 0.01, I2 = 57.3%) and mortality (OR = 0.87, 95% CI 0.74–1.02, P = 0.08; P
hetero = 0.83, I2 = 0) using random- and fixed-effects models, respectively. Low dose alteplase was associated with lower SICH as defined by the National Institute of Neurological Disorders and Stroke study (OR = 0.79, 95% CI 0.64–0.99, P = 0.04; P
hetero = 0.57, I2 = 0) using fixed-effects model. Subgroup and sensitivity analysis could change the results significantly. Current limited evidence was insufficient to support the speculation that low dose alteplase was comparable to standard dose in thrombolytic efficacy and safety in Asian stroke patients.
“…The cut-off points of rt-PA dose and groups that participants were divided into were various across included studies. There was a significant between-group difference in gender in 5 studies 22 , 23 , 25 , 27 , 29 , age in 3 studies 18 , 24 , 30 , time interval from stroke onset to IVT in 2 studies 21 , 24 , and baseline NIHSS score in 1 study 30 . One study had no significant differences in baseline information between the groups being compared 19 .…”
Section: Resultsmentioning
confidence: 98%
“…Of the remaining 18 studies, 7 were excluded (1 for focusing on patients with only mild stroke 47 , 1 for only including 2 patients who received low dose rt-PA 48 , 2 for having unavailable data even after contacting the author 49 , 50 , and 3 for using the data that were completely included in another one with a larger sample size 17 , 19 , 20 , 24 , 28 ). Eleven studies were included in the final meta-analysis 18 , 19 , 21 – 27 , 29 , 30 . Figure 1 Flow diagram of literature search and selection.…”
Section: Resultsmentioning
confidence: 99%
“…In 3 other studies, SICH was identified per author-defined criteria 22 , 29 , 30 , which was nearly the same as the ECASS II definition. One study had zero cases of intracerebral hemorrhage occur 21 . Thus, pooled analyses for SICH were conducted separately based on ECASS (ECASS II, ECASS III, and author-defined criteria), SITS-MOST, and NINDS (Table 1 , Fig.…”
Section: Resultsmentioning
confidence: 99%
“…of standard dose P hetero I 2 Fixed OR (95% CI) Random OR (95% CI) Favorable outcome 11 6076 1230/2842 1587/3594 0.01 57.2% 0.91 (0.82–1.01) 0.94 (0.77–1.15) Mortality 11 6241 250/2951 370/3650 0.89 0 0.93 (0.78–1.11) 0.93 (0.78–1.12) SICH by ECASS 9 6206 134/2713 180/3493 0.037 51.3% 1.01 (0.80–1.27) 0.93 (0.67–1.57) SICH by NINDS 6 4416 123/2054 163/2362 0.51 0 0.79 (0.61–1.01) 0.79 (0.61–1.01) SICH by SITS-MOST 4 4228 33/1936 43/2292 0.05 61.3% 0.90 (0.56–1.44) 1.12 (0.48–2.57) ECASS, the European Cooperative Acute Stroke Study (including ECASS II, ECASS III, and author-defined criteria which were nearly the same as the ECASS II definition); NINDS, the National Institute of Neurological Disorders and Stroke study; SITS-MPST, the Safe Implementation of Thrombolysis in Stroke-Monitoring study. References of included studies 18 , 19 *, 21 – 27 , 29 , 30 . *Non-Asian patients in Anderson’s study (ref.…”
Section: Resultsmentioning
confidence: 99%
“… ECASS, the European Cooperative Acute Stroke Study (including ECASS II, ECASS III, and author-defined criteria which were nearly the same as the ECASS II definition); NINDS, the National Institute of Neurological Disorders and Stroke study; SITS-MPST, the Safe Implementation of Thrombolysis in Stroke-Monitoring study. References of included studies 18 , 19 *, 21 – 27 , 29 , 30 . *Non-Asian patients in Anderson’s study (ref.…”
Whether low dose alteplase is comparable to standard dose in efficacy and safety for intravenous thrombolysis (IVT) in Asian stroke patients remains unverified. PubMed, EMBASE, and Cochrane Library Database from the beginning to June 30, 2017 were searched. IVT efficacy was measured by favorable outcome (modified Rankin Scale scores of 0–1) at 3 months, and safety measured by mortality within 3 months and symptomatic intracerebral hemorrhage (SICH). Pooled estimates were conducted using fixed- or random-effects model depending on heterogeneity. For SICH, studies were pooled separately according to different definitions. Twelve studies involving 7,905 participants were included. No association was found between alteplase dose and favorable outcome (OR = 0.94, 95% CI 0.78–1.14, P = 0.5; heterogeneity: P
hetero = 0.01, I2 = 57.3%) and mortality (OR = 0.87, 95% CI 0.74–1.02, P = 0.08; P
hetero = 0.83, I2 = 0) using random- and fixed-effects models, respectively. Low dose alteplase was associated with lower SICH as defined by the National Institute of Neurological Disorders and Stroke study (OR = 0.79, 95% CI 0.64–0.99, P = 0.04; P
hetero = 0.57, I2 = 0) using fixed-effects model. Subgroup and sensitivity analysis could change the results significantly. Current limited evidence was insufficient to support the speculation that low dose alteplase was comparable to standard dose in thrombolytic efficacy and safety in Asian stroke patients.
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