Gajurel Bikram Prasad, Nepal Gaurav, Kharel Sanjeev, Yadav Jayant Kumar, Yadav Sushil Kumar, Shing Yow Ka, Goeschl Stella, Thapaliya Sahil
Department of Neurology, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
Department of Internal Medicine, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
Clin Neurol Neurosurg. 2022 Apr;215:107205. doi: 10.1016/j.clineuro.2022.107205. Epub 2022 Mar 14.
Acute ischemic stroke (AIS) is a fatal and debilitating condition killing 2.7 million people each year worldwide. The most commonly used treatment modality for AIS is intravenous thrombolysis (IVT) with alteplase which is indicated for those presenting within 4.5 h of onset. Due to a lack of reliable evidence on harm or benefit, the 2019 American Heart Association/American Stroke Association (AHA/ASA) guidelines consider a history of previous intracranial hemorrhage (ICH) as potentially harmful and no longer an absolute contraindication for IVT in patients with AIS, and the U.S. Food and Drug Administration (FDA) removed chronic ICH as a specific contraindication for IVT from the label in 2015. Despite a shift in guidelines, physicians frequently face the dilemmatic choice whether to administer IVT in this subset of patients due to the risk of symptomatic intracranial hemorrhage (SICH). The benefit of IVT in such patients has not been thoroughly investigated, and there are only a few studies on the subject in the literature to date. We conducted the present meta-analysis in an aim to provide solid evidence on the efficacy and safety of IVT for treating AIS in patients with a history of remote ICH. Our meta-analysis found that IVT improves functional outcomes in AIS patients with prior remote ICH without increasing SICH or all-cause mortality. These findings may contribute to the decision-making process for IVT administration in AIS patients.
急性缺血性卒中（AIS）是一种致命且使人衰弱的疾病，全球每年有270万人死于该病。AIS最常用的治疗方式是使用阿替普酶进行静脉溶栓（IVT），适用于发病4.5小时内就诊的患者。由于缺乏关于危害或益处的可靠证据，2019年美国心脏协会/美国卒中协会（AHA/ASA）指南认为既往颅内出血（ICH）史可能有害，不再是AIS患者IVT的绝对禁忌证，并且美国食品药品监督管理局（FDA）于2015年从标签中删除了慢性ICH作为IVT的特定禁忌证。尽管指南有所改变，但由于存在症状性颅内出血（SICH）的风险，医生在这类患者中进行IVT治疗时常常面临两难选择。IVT在此类患者中的益处尚未得到充分研究，迄今为止文献中关于该主题的研究也很少。我们进行了本荟萃分析，旨在为既往有ICH史的AIS患者进行IVT治疗的有效性和安全性提供确凿证据。我们的荟萃分析发现，IVT可改善既往有ICH史的AIS患者的功能结局，且不会增加SICH或全因死亡率。这些发现可能有助于AIS患者IVT治疗的决策过程。
