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Abe, Takeshi; Kazama, Mutsuyoshi; Naito, Iwao; Ueda, Masaiki; Tanaka, T.; Handa, Hiroshi; Saso, Shunichi; Kariyone, S; Yoshimura, Masaharu; Maekawa, Tadashi; Morimatsu, Mitsunori; Moriyasu, Nobuo; Takagi, Sadayuki F.; Maezawa, Hidenori; Kase, M; Kuwana, Nobumasa; Odakura, Tsutomu; Takasu, Kenji; Sugawara, Yuzuru; Takahashi, Akira; Okubo, Mitsuru; Ijichi, Hamao; Yamamoto, Sukeo; Kikuchi, Hiroe; Kito, Shozo; Tokito, Sumitaka; Iwasaki, Yoshinobu

doi:10.2491/jjsth1970.12.321

Cited by 49 publications

(1 citation statement)

References 6 publications

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“… 6 However, the first-generation thrombolytic agent UK, which acts directly to convert plasminogen to plasmin, 7 has also undergone investigations in AIS, 1 8–10 most as low dose administered over several days (240 000–600 000 U/day). 8–10 However, a Chinese national muticentre UK trial showed that two higher doses of UK (1 000 000 or 1 500 000 U/patient) given over 30 min were similarly effective when administered within 6 hours of AIS, 2 which resulted in it being approved for use (class II, level B). 1 3 However, these results were criticised outside of China, 11 which together with its variable supply have made UK seldom used for AIS outside of Asia.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of intravenous r-tPA versus UK for acute ischaemic stroke: a nationwide prospective Chinese registry study

Wang

et al. 2021

Stroke Vasc Neurol

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BackgroundIntravenous recombinant tissue plasminogen activator (r-tPA) and urokinase (UK) are both recommended for the treatment of acute ischaemic stroke (AIS) in China, but with few comparative outcome data being available. We aimed to compare the outcomes of these two thrombolytic agents for the treatment of patients within 4.5 hours of onset of AIS in routine clinical practice in China.MethodsA pre-planned, prospective, nationwide, multicentre, real-world registry of consecutive patients with AIS (age ≥18 years) who received r-tPA or UK within 4.5 hours of symptom onset according to local decision-making and guideline recommendations during 2017–2019. The primary effectiveness outcome was the proportion of patients with an excellent functional outcome (defined by modified Rankin scale scores 0 to 1) at 90 days. The key safety endpoint was symptomatic intracranial haemorrhage according to standard definitions. Multivariable logistic regression was used for comparative analysis, with adjustment according to propensity scores to ensure balance in baseline characteristics.ResultsOverall, 4130 patients with AIS were registered but 320 had incomplete or missing data, leaving 3810 with available data for analysis of whom 2666 received r-tPA (median dose 0.88 (IQR 0.78–0.90) mg/kg) and 1144 received UK (1.71 (1.43–2.00)×104 international unit per kilogram). There were several significant intergroup differences in patient characteristics: r-tPA patients were more educated, had less history of stroke, lower systolic blood pressure, greater neurological impairment and shorter treatment times from symptom onset than UK patients. However, in adjusted analysis, the frequency of excellent outcome (OR 1.18, 95% CI 1.00 to 1.40, p=0.052) and symptomatic intracranial haemorrhage (OR 0.70, 95% CI 0.33 to 1.47, p=0.344) were similar between groups.ConclusionsUK may be as effective and carry a similar safety profile as r-tPA in treating mild to moderate AIS within guidelines in China.Registrationhttp://www.clinicaltrials.gov. unique identifier: NCT02854592.

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