Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Luan, Di; Zhang, Yuanxiang; Yang, Qian; Zhou, Zhiming; Huang, Xianjun; Zhao, Shoucai; Yuan, Lili

doi:10.1155/2019/5406923

Cited by 7 publications

(7 citation statements)

References 43 publications

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“…The difference is that their research subjects were stroke patients with unknown onset times rather than WUS. [26,27] In addition, rt-PA intravenous thrombolysis increased the incidence of SICH in WUS patients in our final outcome assessment, which was inconsistent with previous similar research findings. However, we do not believe that rt-PA intravenous thrombolysis treatment is unreliable for WUS patients.…”

Section: Discussioncontrasting

confidence: 99%

Efficacy and safety of rt-PA intravenous thrombolysis in patients with wake-up stroke

Liu

Zhang

et al. 2022

Medicine

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Background : Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies for patients with acute ischemic stroke. However, wake-up stroke (WUS) is typically excluded from intravenous thrombolytic therapy because of the unclear time of symptom onset. Therefore, we aimed to assess the efficacy and safety of rt-PA intravenous thrombolysis in patients with WUS by meta-analysis.Methods : We completed a systematic literature search of PubMed, Embase, the Cochrane Library, and SinoMed and included relevant studies of WUS patients covering rt-PA thrombolysis and nonthrombolysis (published from January 1, 2000, to February 28, 2021, with no language restrictions). The primary outcomes included safety outcomes and functional outcomes. Safety outcomes were measured according to the incidence of symptomatic intracranial hemorrhage and mortality within 90 days. The efficacy outcomes were measured based on 90-day modified Rankin Scale scores. We assessed pooled data using either a random-effects model (when P < .10, I 2 > 50%) or a fixed-effects model (when P > .10, I 2 < 50%).Results : A total of 913 patients from 9 studies were included in the meta-analysis. All patients had ischemic stroke confirmed by computed tomography or magnetic resonance imaging. The incidence of modified Rankin Scale 0 to 2 was significantly higher in the rt-PA thrombolysis group compared with the nonthrombolysis group. And rt-PA thrombolytic WUS patients did not differ significantly from nonthrombolytic WUS patients in terms of 90-day mortality. However, the incidence of Symptomatic intracranial hemorrhage was also significantly higher in the rt-PA thrombolysis group than that in the nonthrombolysis group.Conclusions : Patients with WUS who received rt-PA thrombolysis had a significant positive effect within 90 days. In addition, although there was no significant increase in mortality, we need to be aware of the risk of intracranial hemorrhage transformation associated with rt-PA thrombolysis despite no obvious increase in mortality. The safety of rt-PA intravenous thrombolysis should be closely monitored in patients with WUS.Abbreviations: CI = confidence interval, MRI = magnetic resonance imaging, mRS = modified Rankin Scale, NOS = Newcastle-Ottawa Scale, rt-PA = recombinant tissue plasminogen activator, SICH = symptomatic intracranial hemorrhage, WUS = wake up stroke.

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Section: Discussioncontrasting

confidence: 99%

Efficacy and safety of rt-PA intravenous thrombolysis in patients with wake-up stroke

Liu

Zhang

et al. 2022

Medicine

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“…It was found that serum BDNF levels in TRD patients increased after rTMS treatment (Figure 1A ). Considering the issue of high heterogeneity, we applied the leave-one-out method to analyze the results[ 56 ], and found that after removing the study of Zhao et al [ 14 ], the heterogeneity decreased from 96% to 11%, and the conclusion that rTMS treatment had no effect on serum BDNF content in TRD patients was reached, which was consistent with the study results of Brunoni et al [ 57 ] (Figure 1B ). BDNF is a macromolecular protein that does not easily cross the blood-brain barrier, which may be responsible for the inconsistency between the results of the above preclinical and clinical studies.…”

Section: Activation Of Endocannabinoid System and Brain Derived Neurosupporting

confidence: 80%

Mechanisms of repetitive transcranial magnetic stimulation for anti-depression: Evidence from preclinical studies

Luan

Zhao

Shi

et al. 2020

WJP

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This review summarizes the anti-depressant mechanisms of repetitive transcranial magnetic stimulation in preclinical studies, including anti-inflammatory effects mediated by activation of nuclear factor-E2-related factor 2 signaling pathway, anti-oxidative stress effects, enhancement of synaptic plasticity and neurogenesis via activation of the endocannabinoid system and brain derived neurotrophic factor signaling pathway, increasing the content of monoamine neurotransmitters via inhibition of Sirtuin 1/monoamine oxidase A signaling pathway, and reducing the activity of the hypothalamic-pituitary-adrenocortical axis. We also discuss the shortcomings of transcranial magnetic stimulation in preclinical studies such as inaccurate positioning, shallow depth of stimulation, and difficulty in elucidating the neural circuit mechanism up- and down-stream of the stimulation target brain region.

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“…To our knowledge, similar articles have been published in the last two years. The difference is that their research subjects were stroke patients with unknown onset times rather than WUS [25,26] . In addition, rt-PA intravenous thrombolysis increased the rate of SICH in WUS patients in our nal outcome assessment, which was inconsistent with previous similar research ndings.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of rt-PA Intravenous Thrombolysis in Patients with Wake-up Stroke: A Meta-Analysis

Liu

Luo

Zhang

et al. 2021

Preprint

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Background Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies for patients with acute ischemic stroke. However, wake-up stroke (WUS) is typically excluded from intravenous thrombolytic therapy because the time of symptom onset is unclear. Therefore, we aimed to assess the efficacy and safety of rt-PA intravenous thrombolysis in patients with WUS by meta-analysis. Methods We completed a systematic literature search of PubMed, Embase, the Cochrane Library, and SinoMed and included relevant studies of WUS patients covering rt-PA thrombolysis and nonthrombolysis (published from January 1, 2000, to February 28, 2021, with no language restrictions). Primary outcomes included safety outcomes and functional outcomes. Safety outcomes was measured according to the incidence of symptomatic intracranial hemorrhage (SICH) and mortality within 90 days. Efficacy outcomes was measured based on 90-day modified Rankin Scale (mRS) score. We assessed pooled data using either a random-effects model (when P < 0.10, I2 > 50%) or a fixed-effects model (when P > 0.10, I2 < 50%). Results Nine studies with 913 patients were included in the meta-analysis. All patients had ischemic stroke confirmed by computed tomography or magnetic resonance imaging. The incidence of mRS 0–2 was significantly higher in the rt-PA thrombolysis group compared with the nonthrombolysis group. And rt-PA thrombolytic WUS patients did not differ significantly from nonthrombolytic WUS patients in terms of 90-day mortality. However, the rate of SICH was also significantly higher in the rt-PA thrombolysis group than that in the nonthrombolysis group. Conclusions Patients with WUS who received rt-PA thrombolysis had a significant positive effect within 90 days. In addition, although there is no significant increase in mortality, we need to be aware of the risk of intracranial hemorrhage transformation associated with rt-PA thrombolysis despite no obvious increase in mortality. The safety of rt-PA intravenous thrombolysis should be closely monitored in patients with WUS.

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Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Cited by 7 publications

References 43 publications

Efficacy and safety of rt-PA intravenous thrombolysis in patients with wake-up stroke

Efficacy and safety of rt-PA intravenous thrombolysis in patients with wake-up stroke

Mechanisms of repetitive transcranial magnetic stimulation for anti-depression: Evidence from preclinical studies

Efficacy and Safety of rt-PA Intravenous Thrombolysis in Patients with Wake-up Stroke: A Meta-Analysis

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