Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
J Coll Physicians Surg Pak. 2022 Mar;32(3):352-358. doi: 10.29271/jcpsp.2022.03.352.
Alteplase is increasingly used for treating ischemic stroke cases with low NIHSS scores, but the guidelines and evidence regarding outcomes are lacking. So, the authors conducted an updated meta-analysis to better understand the effects of alteplase for the treatment of acute mild ischemic stroke. PubMed, Cochrane, EMBASE were systematically explored for all relevant investigations published as in September 2021. Study quality was assessed as per the Cochrane system criteria, and Stata 15.1 was utilised to carry out a meta-analysis. In total, 16 trials incorporating 5,846 patients were analysed (1,926 and 3,920 cases in the rt-PA and non-thrombolytic groups, respectively). The main outcome measure revealed that the treatment of rt-PA was correlated with better odds of a modified Rankin Scale (mRS) score of 0-1 relating to the non-thrombolytic group (OR = 1.12, 95% CI = 1.02-1.23, p <0.05), and with moderate heterogeneity (I2 = 0.0%, p = 0.930). For the secondary study outcomes, symptomatic intracranial hemorrhage incidence was 4.46 times greater in the group of rt-PA, relating to the non-thrombolytic group (OR = 4.46, 95% CI = 2.75-7.23, p <0.001). There were no considerable differences in the mortality between the two groups (OR = 0.64, 95% CI = 0.39-1.03, p >0.05). No significant heterogeneity was detected in secondary study outcomes. Subgroup analysis showed that the function outcomes was the best within 3-4.5 hours; and the risk and mortality of sICH were the lowest within 3-4.5 hours. Intravenous rt-PA administration is associated with improved functional outcomes at three months after the stroke in mild ischemic stroke patients. Key Words: Acute ischemic stroke, Mild, Alteplase, Meta-analysis.
阿替普酶越来越多地用于治疗 NIHSS 评分较低的缺血性脑卒中病例，但缺乏关于结局的指南和证据。因此，作者进行了一项更新的荟萃分析，以更好地了解阿替普酶治疗急性轻度缺血性脑卒中的效果。通过系统地检索 PubMed、Cochrane、EMBASE 数据库，纳入截至 2021 年 9 月所有相关研究。根据 Cochrane 系统标准评估研究质量，并使用 Stata 15.1 进行荟萃分析。共纳入 16 项试验，包含 5846 例患者（阿替普酶组和非溶栓组分别为 1926 例和 3920 例）。主要结局测量显示，阿替普酶治疗与非溶栓组相比，改良 Rankin 量表（mRS）评分 0-1 的优势比更高（OR=1.12，95%CI=1.02-1.23，p<0.05），且存在中度异质性（I2=0.0%，p=0.930）。对于次要研究结局，阿替普酶组症状性颅内出血发生率是非溶栓组的 4.46 倍（OR=4.46，95%CI=2.75-7.23，p<0.001）。两组死亡率无显著差异（OR=0.64，95%CI=0.39-1.03，p>0.05）。次要研究结局无显著异质性。亚组分析显示，3-4.5 小时内功能结局最佳，3-4.5 小时内 sICH 的风险和死亡率最低。静脉内阿替普酶给药可改善轻度缺血性脑卒中患者脑卒中后 3 个月的功能结局。关键词：急性缺血性脑卒中，轻度，阿替普酶，荟萃分析。
