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Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta‐analysis
Objective About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of
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| Published in: | Annals of clinical and translational neurology 2024-12, Vol.11 (12), p.3310-3319 |
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| container_end_page | 3319 |
| container_issue | 12 |
| container_start_page | 3310 |
| container_title | Annals of clinical and translational neurology |
| container_volume | 11 |
| creator | Al‐Janabi, Omar M. Jazayeri, Seyed Behnam Toruno, Michelle A. Mahmood, Yamama M. Ghozy, Sherief Yaghi, Shadi Rabinstein, Alejandro A. Kallmes, David F. |
| description | Objective
About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of |
| doi_str_mv | 10.1002/acn3.52239 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_11292e39c0ec40bcb8524bf012719543</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_11292e39c0ec40bcb8524bf012719543</doaj_id><sourcerecordid>3145668506</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4049-3f46bd08b0b824c1c9ed0087baa095463f51126244af117b6bad0d4c788324043</originalsourceid><addsrcrecordid>eNp9ks1u1DAQgCMEolXphQdAlrigSlv8l8TmglYrfipVcADOlu1Mul4l8WInu-TWI9x4xj4JzqZULQdOHtufvxmPJsueE3xOMKavte3YeU4pk4-yY8qoWMgcs8f34qPsNMYNxpgQmrOSPs2OmOSFLAU-zn5-0TX0I9JdhaCundV2RL5GruuD3kHnh4j6dfCt8c3YO5s2EPR2TMAUIvjRQ1dBhfauq_weDVvUe0T5zfWvtR9CfIOWKI6xh1ZPrwPsHOwP2Vro9c31b93pZowuPsue1LqJcHq7nmTf3r_7uvq4uPz84WK1vFxYjrlcsJoXpsLCYCMot8RKqDAWpdEay5wXrM7TNwvKua4JKU1hdIUrbkshGE0GdpJdzN7K643aBtfqMCqvnToc-HCldEilNqCSSFJg0mJIyY01Iqfc1JjQkqRcLLnezq7tYFqoLExNax5IH950bq2u_C6Zi1SmnAyvbg3Bfx8g9qp10ULT6A5S6xUjlOQSy0Ik9OU_6CY1OHVvonheFCLHRaLOZsoGH2OA-q4agtU0MGoaGHUYmAS_uF__Hfp3PBJAZmDvGhj_o1LL1Sc2S_8A-2PMpQ</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3145668506</pqid></control><display><type>article</type><title>Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta‐analysis</title><source>Open Access: PubMed Central</source><source>Wiley_OA刊</source><source>ProQuest - Publicly Available Content Database</source><creator>Al‐Janabi, Omar M. ; Jazayeri, Seyed Behnam ; Toruno, Michelle A. ; Mahmood, Yamama M. ; Ghozy, Sherief ; Yaghi, Shadi ; Rabinstein, Alejandro A. ; Kallmes, David F.</creator><creatorcontrib>Al‐Janabi, Omar M. ; Jazayeri, Seyed Behnam ; Toruno, Michelle A. ; Mahmood, Yamama M. ; Ghozy, Sherief ; Yaghi, Shadi ; Rabinstein, Alejandro A. ; Kallmes, David F.</creatorcontrib><description>Objective
About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of <4.5 h. This study is to elucidate the safety and efficacy of IVT in the extended therapeutic window (ETW) in patients with AIS.
Methods
Using PRISMA guidelines, a systematic review was conducted using PubMed, Embase, and Scopus. A rigorous risk of bias assessment was conducted using the RoB2 tool. Rates of excellent and good functional outcome (mRS 0–1 and mRS 0–2) at 90 days, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days were pooled using generalized linear mixed model and compared with controls. Meta‐analyses were conducted employing random‐effect models with risk ratio (RR) and 95% confidence intervals (CIs). Subgroup analysis was performed to assess the effect of imaging modalities used for patient selection.
Results
Eight randomized controlled trials (n = 2221, 59% male) were included. At 90 days IVT showed higher rates of functional recovery: mRS 0–1: RR 1.21 95% CI 1.1–1.34, p < 0.001, and mRS 0–2: RR 1.11 95% CI 1.03–1.18, p = 0.004. Rate of mortality at 90 day was not different between groups: RR 1.17 95% CI 0.93–1.48, p = 0.17. However, the rate of sICH was higher among IVT group: RR 2.93 95% CI 1.53–5.6, p = 0.001. Subgroup analysis showed higher mRS 0–1 among patients who were selected based on perfusion imaging (p < 0.05).
Interpretation
The use of IVT in AIS in ETW is beneficial especially with the use of perfusion imaging for patients' selection.</description><identifier>ISSN: 2328-9503</identifier><identifier>EISSN: 2328-9503</identifier><identifier>DOI: 10.1002/acn3.52239</identifier><identifier>PMID: 39469780</identifier><language>eng</language><publisher>United States: John Wiley & Sons, Inc</publisher><subject>Administration, Intravenous ; Age ; Clinical trials ; Fibrinolytic Agents - administration & dosage ; Fibrinolytic Agents - adverse effects ; Humans ; Ischemia ; Ischemic Stroke - drug therapy ; Ischemic Stroke - mortality ; Mortality ; Patients ; Stroke ; Systematic review ; Thrombolytic Therapy - adverse effects ; Thrombolytic Therapy - methods ; Time-to-Treatment ; Tissues</subject><ispartof>Annals of clinical and translational neurology, 2024-12, Vol.11 (12), p.3310-3319</ispartof><rights>2024 The Author(s). published by Wiley Periodicals LLC on behalf of American Neurological Association.</rights><rights>2024 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.</rights><rights>2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c4049-3f46bd08b0b824c1c9ed0087baa095463f51126244af117b6bad0d4c788324043</cites><orcidid>0000-0001-5629-3023 ; 0000-0003-0031-1004 ; 0000-0003-2208-4308</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/3145668506/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3145668506?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,11561,25752,27923,27924,37011,37012,44589,46051,46475,53790,53792,74897</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39469780$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Al‐Janabi, Omar M.</creatorcontrib><creatorcontrib>Jazayeri, Seyed Behnam</creatorcontrib><creatorcontrib>Toruno, Michelle A.</creatorcontrib><creatorcontrib>Mahmood, Yamama M.</creatorcontrib><creatorcontrib>Ghozy, Sherief</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Rabinstein, Alejandro A.</creatorcontrib><creatorcontrib>Kallmes, David F.</creatorcontrib><title>Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta‐analysis</title><title>Annals of clinical and translational neurology</title><addtitle>Ann Clin Transl Neurol</addtitle><description>Objective
About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of <4.5 h. This study is to elucidate the safety and efficacy of IVT in the extended therapeutic window (ETW) in patients with AIS.
Methods
Using PRISMA guidelines, a systematic review was conducted using PubMed, Embase, and Scopus. A rigorous risk of bias assessment was conducted using the RoB2 tool. Rates of excellent and good functional outcome (mRS 0–1 and mRS 0–2) at 90 days, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days were pooled using generalized linear mixed model and compared with controls. Meta‐analyses were conducted employing random‐effect models with risk ratio (RR) and 95% confidence intervals (CIs). Subgroup analysis was performed to assess the effect of imaging modalities used for patient selection.
Results
Eight randomized controlled trials (n = 2221, 59% male) were included. At 90 days IVT showed higher rates of functional recovery: mRS 0–1: RR 1.21 95% CI 1.1–1.34, p < 0.001, and mRS 0–2: RR 1.11 95% CI 1.03–1.18, p = 0.004. Rate of mortality at 90 day was not different between groups: RR 1.17 95% CI 0.93–1.48, p = 0.17. However, the rate of sICH was higher among IVT group: RR 2.93 95% CI 1.53–5.6, p = 0.001. Subgroup analysis showed higher mRS 0–1 among patients who were selected based on perfusion imaging (p < 0.05).
Interpretation
The use of IVT in AIS in ETW is beneficial especially with the use of perfusion imaging for patients' selection.</description><subject>Administration, Intravenous</subject><subject>Age</subject><subject>Clinical trials</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Ischemic Stroke - mortality</subject><subject>Mortality</subject><subject>Patients</subject><subject>Stroke</subject><subject>Systematic review</subject><subject>Thrombolytic Therapy - adverse effects</subject><subject>Thrombolytic Therapy - methods</subject><subject>Time-to-Treatment</subject><subject>Tissues</subject><issn>2328-9503</issn><issn>2328-9503</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp9ks1u1DAQgCMEolXphQdAlrigSlv8l8TmglYrfipVcADOlu1Mul4l8WInu-TWI9x4xj4JzqZULQdOHtufvxmPJsueE3xOMKavte3YeU4pk4-yY8qoWMgcs8f34qPsNMYNxpgQmrOSPs2OmOSFLAU-zn5-0TX0I9JdhaCundV2RL5GruuD3kHnh4j6dfCt8c3YO5s2EPR2TMAUIvjRQ1dBhfauq_weDVvUe0T5zfWvtR9CfIOWKI6xh1ZPrwPsHOwP2Vro9c31b93pZowuPsue1LqJcHq7nmTf3r_7uvq4uPz84WK1vFxYjrlcsJoXpsLCYCMot8RKqDAWpdEay5wXrM7TNwvKua4JKU1hdIUrbkshGE0GdpJdzN7K643aBtfqMCqvnToc-HCldEilNqCSSFJg0mJIyY01Iqfc1JjQkqRcLLnezq7tYFqoLExNax5IH950bq2u_C6Zi1SmnAyvbg3Bfx8g9qp10ULT6A5S6xUjlOQSy0Ik9OU_6CY1OHVvonheFCLHRaLOZsoGH2OA-q4agtU0MGoaGHUYmAS_uF__Hfp3PBJAZmDvGhj_o1LL1Sc2S_8A-2PMpQ</recordid><startdate>202412</startdate><enddate>202412</enddate><creator>Al‐Janabi, Omar M.</creator><creator>Jazayeri, Seyed Behnam</creator><creator>Toruno, Michelle A.</creator><creator>Mahmood, Yamama M.</creator><creator>Ghozy, Sherief</creator><creator>Yaghi, Shadi</creator><creator>Rabinstein, Alejandro A.</creator><creator>Kallmes, David F.</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><general>Wiley</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M2M</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-5629-3023</orcidid><orcidid>https://orcid.org/0000-0003-0031-1004</orcidid><orcidid>https://orcid.org/0000-0003-2208-4308</orcidid></search><sort><creationdate>202412</creationdate><title>Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta‐analysis</title><author>Al‐Janabi, Omar M. ; Jazayeri, Seyed Behnam ; Toruno, Michelle A. ; Mahmood, Yamama M. ; Ghozy, Sherief ; Yaghi, Shadi ; Rabinstein, Alejandro A. ; Kallmes, David F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4049-3f46bd08b0b824c1c9ed0087baa095463f51126244af117b6bad0d4c788324043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Administration, Intravenous</topic><topic>Age</topic><topic>Clinical trials</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemic Stroke - drug therapy</topic><topic>Ischemic Stroke - mortality</topic><topic>Mortality</topic><topic>Patients</topic><topic>Stroke</topic><topic>Systematic review</topic><topic>Thrombolytic Therapy - adverse effects</topic><topic>Thrombolytic Therapy - methods</topic><topic>Time-to-Treatment</topic><topic>Tissues</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Al‐Janabi, Omar M.</creatorcontrib><creatorcontrib>Jazayeri, Seyed Behnam</creatorcontrib><creatorcontrib>Toruno, Michelle A.</creatorcontrib><creatorcontrib>Mahmood, Yamama M.</creatorcontrib><creatorcontrib>Ghozy, Sherief</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Rabinstein, Alejandro A.</creatorcontrib><creatorcontrib>Kallmes, David F.</creatorcontrib><collection>Wiley_OA刊</collection><collection>Wiley Online Library Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Complete (ProQuest Database)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Psychology Database</collection><collection>ProQuest - Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Annals of clinical and translational neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Al‐Janabi, Omar M.</au><au>Jazayeri, Seyed Behnam</au><au>Toruno, Michelle A.</au><au>Mahmood, Yamama M.</au><au>Ghozy, Sherief</au><au>Yaghi, Shadi</au><au>Rabinstein, Alejandro A.</au><au>Kallmes, David F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta‐analysis</atitle><jtitle>Annals of clinical and translational neurology</jtitle><addtitle>Ann Clin Transl Neurol</addtitle><date>2024-12</date><risdate>2024</risdate><volume>11</volume><issue>12</issue><spage>3310</spage><epage>3319</epage><pages>3310-3319</pages><issn>2328-9503</issn><eissn>2328-9503</eissn><abstract>Objective
About 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of <4.5 h. This study is to elucidate the safety and efficacy of IVT in the extended therapeutic window (ETW) in patients with AIS.
Methods
Using PRISMA guidelines, a systematic review was conducted using PubMed, Embase, and Scopus. A rigorous risk of bias assessment was conducted using the RoB2 tool. Rates of excellent and good functional outcome (mRS 0–1 and mRS 0–2) at 90 days, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days were pooled using generalized linear mixed model and compared with controls. Meta‐analyses were conducted employing random‐effect models with risk ratio (RR) and 95% confidence intervals (CIs). Subgroup analysis was performed to assess the effect of imaging modalities used for patient selection.
Results
Eight randomized controlled trials (n = 2221, 59% male) were included. At 90 days IVT showed higher rates of functional recovery: mRS 0–1: RR 1.21 95% CI 1.1–1.34, p < 0.001, and mRS 0–2: RR 1.11 95% CI 1.03–1.18, p = 0.004. Rate of mortality at 90 day was not different between groups: RR 1.17 95% CI 0.93–1.48, p = 0.17. However, the rate of sICH was higher among IVT group: RR 2.93 95% CI 1.53–5.6, p = 0.001. Subgroup analysis showed higher mRS 0–1 among patients who were selected based on perfusion imaging (p < 0.05).
Interpretation
The use of IVT in AIS in ETW is beneficial especially with the use of perfusion imaging for patients' selection.</abstract><cop>United States</cop><pub>John Wiley & Sons, Inc</pub><pmid>39469780</pmid><doi>10.1002/acn3.52239</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5629-3023</orcidid><orcidid>https://orcid.org/0000-0003-0031-1004</orcidid><orcidid>https://orcid.org/0000-0003-2208-4308</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Open Access: PubMed Central; Wiley_OA刊; ProQuest - Publicly Available Content Database |
| subjects | Administration, Intravenous Age Clinical trials Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Humans Ischemia Ischemic Stroke - drug therapy Ischemic Stroke - mortality Mortality Patients Stroke Systematic review Thrombolytic Therapy - adverse effects Thrombolytic Therapy - methods Time-to-Treatment Tissues |
| title | Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta‐analysis |
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