Comparative study on the efficacy and safety of alteplase and urokinase in the treatment of acute cerebral infarction

Bao, Hua; Gao, Haokao; Pan, Mengtong; Zhao, Lei; Sun, Haibin

doi:10.3233/thc-202382

Cited by 14 publications

(9 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The symptomatic ICH rates were similar among the three groups ( 5 ). Recently, several comparative studies on the efficacy and safety of alteplase and urokinase for treating acute ischemic stroke have been conducted ( 13 – 15 ). These studies all demonstrated that urokinase and alteplase have similar therapeutic effects.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

et al. 2021

View full text Add to dashboard Cite

Background: Intravenous thrombolysis with alteplase benefits eligible patients with acute ischemic stroke. However, in some countries such as China, alteplase may be too expensive for low-income patients, and also for regions with low economic development. Urokinase is much less expensive than alteplase. This study aimed to assess the outcomes and treatment complications of urokinase in acute ischemic stroke patients, which are poorly understood.Methods: This multicenter retrospective study included acute ischemic stroke patients who received intravenous urokinase or alteplase from January 2014 to January 2018 at 21 centers in China. Outcomes and treatment complications were analyzed by univariate and multivariate analyses.Results: Among the 618 patients included in this study, 489 were treated with urokinase and 129 were treated with alteplase. Functional independence, no/minimal disability, mortality, intracranial hemorrhage (ICH), and symptomatic ICH did not significantly differ between the urokinase and alteplase groups in the univariate and multivariate analyses. However, the patients who received alteplase had a lower odds ratio (OR) of extracranial bleeding in the univariate analysis and a lower adjusted OR (aOR) in the multivariate analysis than the patients who received urokinase (OR = 0.410 [95% CI, 0.172–0.977], p = 0.038; aOR = 0.350 [95% CI, 0.144–0.854], p = 0.021). Furthermore, in patients treated with urokinase, the patients who received high-dose urokinase had a higher OR of extracranial bleeding in the univariate analysis and a higher aOR of extracranial bleeding in the multivariate analysis than patients who received low-dose urokinase (OR = 3.046 [95% CI, 1.696–5.470], p < 0.001; aOR = 3.074 [95% CI, 1.627–5.807], p = 0.001). Moreover, patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase.Conclusions: Patients treated with urokinase had similar outcomes but a higher risk of extracranial bleeding compared to patients treated with alteplase. The risk of extracranial bleeding was higher in the patients treated with high-dose urokinase than in the patients treated with low-dose urokinase. Patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase. In countries such as China where some acute ischemic stroke patients cannot afford alteplase, urokinase may be a good alternative to alteplase for intravenous thrombolysis.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Sun et al reported that the ICH risk of alteplase was lower than urokinase ( 14 ). Bao et al found that patients treated with urokinase had a lower frequency of bleeding ( 13 ). Wang et al reported that the rates of subcutaneous ecchymosis, gingival bleeding, and ICH were similar between urokinase and alteplase ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The screening process is summarized in Figure 1. Thirty RCTs 28–57 met our inclusion criteria. The main characteristics of the included studies are provided in Table .…”

Section: Resultsmentioning

confidence: 99%

Comparative efficacy and safety of glycerol versus mannitol in patients with cerebral oedema and elevated intracranial pressure: A systematic review and meta‐analysis

et al. 2020

View full text Add to dashboard Cite

What is known and objective Glycerol is thought to be superior to mannitol in the treatment of cerebral oedema and elevated intracranial pressure (ICP), particularly with safety concerns. However, the current evidence remains insufficient. Therefore, we aimed to compare the efficacy and safety of glycerol versus mannitol in this meta‐analysis. Methods PubMed, EMBASE, Web of Science, CENTRAL, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP information, ClinicalTrials.gov, and the reference lists of relevant articles were searched for randomized controlled trials comparing glycerol and mannitol in patients with brain oedema and elevated ICP. Two investigators independently identified the articles, assessed the study quality and extracted data. Data analyses were performed using RevMan software. Results and discussion Thirty trials involving 3144 patients met our inclusion criteria. Pooled data indicated that glycerol and mannitol had comparable effectiveness in controlling cerebral oedema (RR, 1.00; 95% CI, 0.97 to 1.03; p = .97), but the risks of acute kidney injury and electrolyte disturbances were significantly lower with glycerol (RR, 0.21; 95% CI, 0.16 to 0.27 and RR, 0.23; 95% CI, 0.17 to 0.30, respectively) than mannitol. Moreover, there seemed to be a lower probability of rebound ICP after the withdrawal of glycerol. Neither haemolysis nor elevated blood glucose levels were observed in the glycerol group. What is new and conclusion Regarding the balance between efficacy and safety, glycerol could be an effective and more tolerable alternative therapy for cerebral oedema and elevated ICP than mannitol, especially for high‐risk populations of renal failure.

show abstract

“…Within the day of alteplase therapy, therapy of aspirin and clopidogrel [2][3][4] is not allowed. Observation index: Record NIHSS score of two groups of acute cerebral infarction patients before and after treatment, as well as adverse reactions of patients during treatment [5][6][7] . Efficacy evaluation index: With a view on NIHSS score of acute cerebral infarction, clinical efficacy of this study is divided into three levels, namely, effective, ineffective and markedly effective [8][9][10][11] .…”

Section: Et Al: Alteplase In the Treatment Of Acute Cerebral Infarctionmentioning

confidence: 99%

Application Safety of Alteplase in the Treatment of Acute Cerebral Infarction

Li¹,

Wang²,

Yan³

et al. 2021

ijps

View full text Add to dashboard Cite

This study focuses on clinical effect of alteplase in the treatment of acute cerebral infarction. 100 cases of patients with acute cerebral infarction admitted to our hospital during 2014-2015 were randomly selected as study objects and divided into groups according to different therapeutic methods, with 50 cases in the observation group and the control group respectively. The control group received conventional non thrombolytic therapy. On this basis, the observation group received thrombolytic therapy with alteplase. Efficacy of the two groups was compared. Clinical efficacy of the observation group was more significant than that of the control group, with adverse reaction rates lower than that of the control group. Application of alteplase in treatment of acute cerebral infarction is with significant efficacy and high safety.

show abstract

Comparative study on the efficacy and safety of alteplase and urokinase in the treatment of acute cerebral infarction

Cited by 14 publications

References 16 publications

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

Comparative efficacy and safety of glycerol versus mannitol in patients with cerebral oedema and elevated intracranial pressure: A systematic review and meta‐analysis

Application Safety of Alteplase in the Treatment of Acute Cerebral Infarction

Contact Info

Product

Resources

About