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Intravenous Alteplase for Stroke With Unknown Time of Onset Guided by Advanced Imaging: Systematic Review and Meta-Analysis of Individual Patient Data

By Currents Editor posted 11-24-2020 13:45


The Lancet (11/14/20) Vol. 396, No. 10262, P. 1574  doi: 10.1016/S0140-6736(20)32163-2
Thomalla, Götz; Boutitie, Florent; Ma, Henry; et al.


Although stroke patients with unknown time of onset have previously been ruled out for thrombolysis, researchers questioned whether the strategy would work in cases where imaging biomarkers have identified salvageable tissue. To learn more, they conducted a systematic review and meta-analysis involving four randomized clinical trials that met inclusion criteria. Each of the studies—WAKE-UP, EXTEND, THAWS, and ECASS-4—compared I.V. alteplase with usual care or placebo in adult stroke patients with unknown time of onset. The literature provided individual patient data on 843 participants, randomized to receive alteplase or standard treatment. Investigators recorded a favorable functional outcome at 90-day followup in 47% of the alteplase cohort and 39% of the control group. Although there was an increase in risk for symptomatic intracranial hemorrhage and more deaths among the alteplase patients, the intervention was associated with fewer cases of severe disability or death.


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