| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom.
Address correspondence and reprint requests to Dr. J.M. Wardlaw, Dept. of Clinical Neurosciences, Western General Hospital, Crewe Rd., Edinburgh EH4 2XU, UK.
The Cochrane Database of Systematic Reviews summarizes all the existing randomized evidence of all treatments for all diseases, so that doctors can quickly access the most up-to-date information. The trials for the Cochrane systematic review of thrombolytic therapy in acute ischemic stroke were identified from extensive searching of the literature and contact with trial investigators. Data on several prespecified outcomes (death and symptomatic intracranial hemorrhages within the first 7 to 10 days after treatment, and death and poor functional outcome at long-term follow-up) were sought in each identified randomized, controlled trial. There have thus far been 17 completed randomized, controlled trials of thrombolytic therapy versus control in 5,216 patients (including the provisional data from the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke [ATLANTIS] A and B and Recombinant Prourokinase in Acute Cerebral Thromboembolism [PROACT] II trials). Of these, eight trials tested recombinant tissue plasminogen activator (rt-PA) in 2,889 patients (56% of all data). Overall, there was an increase in the odds of death within the first 10 days (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.48 to 2.32) and symptomatic intracranial hemorrhage (OR 3.53, 95% CI 2.79 to 4.45) with thrombolysis (slightly less with rt-PA). The odds of death at the end of follow-up were also slightly increased with thrombolysis (OR 1.31, 95% CI 1.13 to 1.52), although this increase was not significant in patients receiving rt-PA. Despite this, overall there was a significant reduction in the number of patients with a poor functional outcome (combined death or dependency) at the end of follow-up (OR 0.83, 95% CI 0.73 to 0.94), which was slightly better in patients receiving rt-PA. Most of the data came from trials testing thrombolysis up to 6 hours after stroke, but the subgroup of patients treated within 3 hours showed a greater reduction in poor functional outcome with thrombolysis (OR 0.58, 95% CI 0.46 to 0.74) with a less adverse effect on death. The available data do not allow much further subgroup analysis, although there is reasonable evidence to indicate that aspirin or heparin given within 24 hours of thrombolytic therapy causes a significant increase in intracranial hemorrhage and death. It is hoped that a meta-analysis using individual patient data may be able to address the effect of thrombolysis in further specific subgroups and examine the interaction between the severity of stroke and the effect of thrombolysis.
This article has been cited by other articles:
|
|
 |
|
  S. Schulman, R. J. Beyth, C. Kearon, and M. N. Levine Hemorrhagic Complications of Anticoagulant and Thrombolytic Treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 257S - 298S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 630S - 669S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S D Treadwell, B Thanvi, and T G Robinson Stroke in pregnancy and the puerperium Postgrad. Med. J., May 1, 2008; 84(991): 238 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Albers, P. Amarenco, J. D. Easton, R. L. Sacco, and P. Teal Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 483S - 512S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S. Carter, J. D. Rabinov, R. Pfannl, and L. H. Schwamm Case 5-2004 - A 57-Year-Old Man with Slurred Speech and Left Hemiparesis N. Engl. J. Med., February 12, 2004; 350(7): 707 - 716. [Full Text] [PDF]
|
|
|
|
 |
|
 B. F. Tomandl, E. Klotz, R. Handschu, B. Stemper, F. Reinhardt, W. J. Huk, K.E. Eberhardt, and S. Fateh-Moghadam Comprehensive Imaging of Ischemic Stroke with Multisection CT RadioGraphics, May 1, 2003; 23(3): 565 - 592. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Elford, A. Leader, R. Wee, and P.K. Stys Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intra-arterial rt-PA Neurology, October 22, 2002; 59(8): 1270 - 1272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kucinski, O. Vaterlein, V. Glauche, J. Fiehler, E. Klotz, B. Eckert, C. Koch, J. Rother, and H. Zeumer Correlation of Apparent Diffusion Coefficient and Computed Tomography Density in Acute Ischemic Stroke Stroke, July 1, 2002; 33(7): 1786 - 1791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A Donnan Review: thrombolysis increases short term death and intracranial haemorrhage but decreases long term death or dependence Evid. Based Med., March 1, 2002; 7(2): 48 - 48. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
