Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

Publication date: 29 November–5 December 2014 Source:The Lancet, Volume 384, Issue 9958 Author(s): Jonathan Emberson , Kennedy R Lees , Patrick Lyden , Lisa Blackwell , Gregory Albers , Erich Bluhmki , Thomas Brott , Geoff Cohen , Stephen Davis , Geoffrey Donnan , James Grotta , George Howard , Markku Kaste , Masatoshi Koga , Ruediger von Kummer , Maarten Lansberg , Richard I Lindley , Gordon Murray , Jean Marc Olivot , Mark Parsons , Barbara Tilley , Danilo Toni , Kazunori Toyoda , Nils Wahlgren , Joanna Wardlaw , William Whiteley , Gregory J del Zoppo , Colin Baigent , Peter Sandercock , Werner Hacke Background Alteplase is effective for treatment of acute ischaemic stroke but debate continues about its use after longer times since stroke onset, in older patients, and among patients who have had the least or most severe strokes. We assessed the role of these factors in affecting good stroke outcome in patients given alteplase. Methods We did a pre-specified meta-analysis of individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control. We included all completed randomised phase 3 trials of intravenous alteplase for treatment of acute ischaemic stroke for which data were available. Retrospective checks confirmed that no eligible trials had been omitted. We defined a good stroke outcome as no significant disability at 3–6 months, defined by a modified Rankin Score of 0 or 1. Additi...
Source: The Lancet - Category: Journals (General) Source Type: research