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Related Experiment Videos

Thrombolysis for acute ischaemic stroke.

J M Wardlaw1, G del Zoppo, T Yamaguchi

  • 1Neurosciences Trials Unit, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. jmw@skull.dcn.ed.ac.uk

The Cochrane Database of Systematic Reviews
|May 5, 2000
PubMed
Summary

Thrombolytic therapy for acute ischemic stroke increases early and late deaths, primarily due to brain bleeds. However, it reduces overall disability in survivors, offering a net benefit, especially when administered within three hours.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Acute ischemic stroke is often caused by cerebral artery blockages.
  • Thrombolytic drugs can mitigate stroke damage but risk severe intracranial hemorrhage.
  • Several randomized trials have investigated thrombolytic therapy for acute ischemic stroke.

Purpose of the Study:

  • To systematically evaluate the safety and efficacy of thrombolytic agents in patients experiencing acute ischemic stroke.
  • To analyze the benefits and risks associated with thrombolytic therapy in stroke management.

Main Methods:

  • Conducted a comprehensive literature search using the Cochrane Stroke Review Group strategy, supplemented by direct contact with researchers and pharmaceutical companies.
  • Included randomized trials comparing any thrombolytic agent against control in patients with confirmed ischemic stroke.

Related Experiment Videos

  • Extracted and verified data from 17 trials involving 5216 patients, assessing trial quality and employing double-blind methods where applicable.

    • Main Results:

    • Thrombolytic therapy significantly increased early (within 10 days) and overall mortality, largely due to fatal intracranial hemorrhage.
    • Despite increased hemorrhage risk, thrombolytic therapy significantly reduced the proportion of patients who were dead or dependent at follow-up, particularly when administered within three hours.
    • Intravenous recombinant tissue plasminogen activator (rt-PA) showed a trend towards less hazard and more benefit, though heterogeneity in trial design and patient selection was noted.

    Conclusions:

    • Thrombolytic therapy for acute ischemic stroke presents a complex risk-benefit profile, increasing mortality from intracranial hemorrhage but reducing long-term disability.
    • Intravenous rt-PA appears to offer a potentially more favorable balance of risk and benefit compared to other agents or administration routes.
    • Further research is needed to optimize patient selection, determine ideal treatment parameters (agent, dose, route), and minimize adverse effects.