scholarly journals Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis

2018 ◽  
Vol 3 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Shoujiang You ◽  
Anubhav Saxena ◽  
Xia Wang ◽  
WeeYong Tan ◽  
Qiao Han ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Meta Analysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Efficacy And Safety ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Iv Tpa

The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL) , from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0–1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I2=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I2=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I2=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.

scholarly journals Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis

The Lancet ◽  
2012 ◽  
Vol 379 (9834) ◽  
pp. 2364-2372 ◽  
Author(s):  
Joanna M Wardlaw ◽  
Veronica Murray ◽  
Eivind Berge ◽  
Gregory del Zoppo ◽  
Peter Sandercock ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischaemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
Meta Analysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Abstract T P53: Implementation and Outcome of Intravenous Recombinant Tissue Plasminogen Activator Administered 3-4.5 hour after Stroke in Korea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tai Hwan Park ◽  
Keun-Sik Hong ◽  
Sang-Soon Park ◽  
Youngchai Ko ◽  
Soo Joo Lee ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Time Window ◽  
Recombinant Tissue Plasminogen Activator ◽  
Nihss Score ◽  
Excellent Outcome ◽  
Tissue Plasminogen ◽  
The Difference ◽  
Ischemic Attack ◽  
Iv Tpa

Background: Although the benefit of intravenous recombinant tissue plasminogen activator (IV-TPA) has been proved in patients with 3-4.5 hour after stroke from a randomized trial and observational studies, in which most subjects were Western population. We aimed to determined the safety and efficacy of IV-TPA within the 3- to 4.5-hour window in Korean population. Methods: Using a prospective, web-based registry of consecutive patients with acute stroke or transient ischemic attack (TIA) admitted to 12 academic hospitals in Korea, we enrolled 616 patients receiving IV-TPA therapy within 3 hours and 107 within 3-4.5 hours after stroke onset for this study. Functional outcome measured by modified Rankin scale (mRS) at 3 months after stroke was compared between the two time window cohorts. Symptomatic intracranial hemorrhage (SICH) defined as any apparently extravascular blood in the brain or within the cranium associated with 4 points or more increase in the National Institutes of Health Stroke Scale (NIHSS) score or leading to death was evaluated for safety. Odds ratios (OR) and 95% confidence intervals (CI) was calculated to present the probability of achieving each outcome for patients treated within 3-4.5 hours compared to those treated within 3 hours. Results: The excellent outcome (mRS 0-1) was less often achieved in the 3-4.5 hours cohort than in the within 3 hours cohort (39.3% vs 42.9%), but the difference was not statistically significant after adjusting for age, sex, baseline NIHSS score, weight, glucose, center (adjusted OR [95% CI], 1.26 [0.60-2.65]). The proportion of mRS 0-2 at 3 months (48.6% vs55.7%) was not also different between two groups (adjusted OR [95% CI], 0.80 [0.41-1.54]). The rate of SICH was higher in the 3-4.5 hours cohort than in the within 3 hours cohort (4.7% vs 3.1%), but the difference was not statistically significant (adjusted OR [95% CI], 0.81 [0.20-3.35]). Conclusion: This study shows that IV-TPA therapy within the 3- to 4.5-hour window after ischemic stroke is safe and effective in Korean patients.

scholarly journals Medicolegal Considerations with Intravenous Tissue Plasminogen Activator in Stroke: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Archit Bhatt ◽  
Adnan Safdar ◽  
Dhara Chaudhari ◽  
Diane Clark ◽  
Amber Pollak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Malpractice Litigation ◽  
Extensive Search ◽  
Intravenous Tissue Plasminogen Activator ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background.Intravenous tPA (tissue plasminogen activator) therapy remains underutilized in patients with Acute Ischemic Stroke (AIS). Anecdotal data indicates that physicians are increasingly liable for administering and for failure to administer tPA.Methods.An extensive search of Medline, Embase, Westlaw, LexisNexis Legal, and Google Scholar databases was performed. Case studies that involved malpractice litigation in ischemic stroke and thrombolytic therapy were analyzed systematically.Results.We identified 789 ischemic stroke litigation cases, of which 46 cases were related to intravenous tPA and stroke litigation. Case descriptions of 40 cases were available. Data for verdicts were available for 38 patients. The most frequent plaintiff claim was related to failure to administer intravenous tPA (38, 95%). Only 2 (5.0%) claim involved complications of treatment with tPA. Hospitals were defendants in majority of the 36 cases. Physicians were involved in 33 cases. While ED physicians were involved in 25 (60.52%) cases, neurologists were involved in 8 (20.0%) cases. There were 26 (65%) defendant-favored and 12 (30%) plaintiff-favored verdicts.Conclusion.Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred.

The natural tissue plasminogen activator inhibitor neuroserpin and acute ischaemic stroke outcome

2011 ◽  
Vol 105 (03) ◽  
pp. 421-429 ◽  
Author(s):  
Tomás Sobrino ◽  
Elena Miranda ◽  
David Brea ◽  
Natalia Pérez de la Ossa ◽  
Miguel Blanco ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
High Serum ◽  
Favourable Outcome ◽  
Neuroprotective Effects ◽  
Good Functional Outcome ◽  
Tissue Plasminogen

SummaryNeuroserpin is a brain-derived natural inhibitor of tissue plasminogen activator (tPA) that has shown neuroprotective effects in animal models of brain ischaemia. Our aim was to investigate the association of neuroserpin levels in blood with functional outcome in patients with acute ischaemic stroke. Due to the potential effect of tPA treatment interfering on neuroserpin levels, we studied two different cohorts: 129 patients not treated with tPA and 80 patients treated with intravenous tPA within 3 hours (h) from symptoms onset. Neuroserpin levels were measured by ELISA. Good functional outcome at three months was defined as Rankin scale score ≤2. In the two cohorts, serum neuroserpin levels on admission were significantly higher than at 24 h, 72 h and in healthy subjects. In non tPA-treated patients, neuroserpin levels decrease at 24 h, but not levels at baseline, were associated with good outcome (for each quartile decrease, adjusted odds ratio [OR] 15.0; 95% confidence interval [CI], 3.5 to 66). In the tPA-treated cohort, high neuroserpin levels before tPA bolus had the stronger effect on favourable outcome (for each quartile, OR 13.5; 95%CI, 3.9 to 47). Furthermore, for each quartile in neuroserpin levels before tPA bolus there was a 80% (95%CI, 48 to 92) reduction in the probability of subsequent parenchymal haematoma. In summary, high serum neuroserpin levels before intravenous tPA and neuroserpin levels decrease at 24 h after ischaemic stroke, independently of tPA treatment, are associated with good functional outcome. These findings support the concept that neuroserpin might play an important role during cerebral ischaemia.

Sign in / Sign up

Export Citation Format

Share Document