Thrombolysis for Ischemic Stroke Beyond the 4.5-Hour Window: A Meta-Analysis of Randomized Clinical Trials.
Publication/Presentation Date
3-1-2025
Abstract
BACKGROUND: A minority of patients with stroke qualify for intravenous thrombolysis (IVT) within 4.5-hour window. The safety and efficacy of IVT beyond this period have not been well studied.
METHODS: We systematically searched MEDLINE, Embase, Cochrane, and ClinicalTrials.gov for relevant randomized clinical trials. Randomized clinical trials comparing IVT versus standard medical care in patients with ischemic stroke beyond 4.5 hours of symptom onset or last known well without mechanical thrombectomy (MT) were included. Primary outcomes were excellent (modified Rankin Scale score of 0-1) and good (modified Rankin Scale score of 0-2) functional outcomes at 90 days, symptomatic intracerebral hemorrhage (sICH), and death at 90 days. Pooled odds ratios (ORs) with 95% CIs were calculated using a random-effects model. Heterogeneity was assessed by
RESULTS: Eight randomized clinical trials (1742 patients; mean age, 69.8±9 years, 63.5% men) were included. Compared with standard medical care, IVT achieved higher rates of excellent (OR, 1.43 [95% CI, 1.17-1.75];
CONCLUSIONS: IVT for ischemic stroke beyond 4.5 hours, without MT, led to increased odds of excellent and good functional outcomes compared with standard medical care, despite higher odds of sICH, and a nonsignificant numerical increase in mortality.
Volume
56
Issue
3
First Page
580
Last Page
590
ISSN
1524-4628
Published In/Presented At
Günkan, A., Ferreira, M. Y., Vilardo, M., Scarcia, L., Bocanegra-Becerra, J. E., Cardoso, L. J. C., Fabrini Paleare, L. F., de Oliveira Almeida, G., Semione, G., Ferreira, C., Ciccio, G., Mujanovic, A., Jabbour, P., Serulle, Y., Nguyen, T. N., & Baron, J. C. (2025). Thrombolysis for Ischemic Stroke Beyond the 4.5-Hour Window: A Meta-Analysis of Randomized Clinical Trials. Stroke, 56(3), 580–590. https://doi.org/10.1161/STROKEAHA.124.048536
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
39882605
Department(s)
Administration and Leadership
Document Type
Article