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05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolysis for acute ischaemic stroke.
Joanna M Wardlaw1, Veronica Murray, Eivind Berge
1Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, UK, EH4 2XU.
The Cochrane Database of Systematic Reviews
|October 13, 2009
Summary
Thrombolytic therapy for acute ischemic stroke significantly reduces death and dependency, despite increasing bleeding risks. Early treatment within three hours shows greater benefits and fewer fatal complications.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Ischemic stroke, often caused by cerebral artery blockages, necessitates prompt treatment to prevent brain damage and improve recovery.
- Thrombolytic drugs, while effective in restoring blood flow, carry a risk of fatal intracranial hemorrhage.
- Recombinant tissue plasminogen activator (rt-PA) is a licensed thrombolytic for select stroke patients within a three-hour window.
Purpose of the Study:
- To evaluate the safety and efficacy of thrombolytic agents in patients experiencing acute ischemic stroke.
- To synthesize evidence from randomized trials on thrombolytic therapy outcomes.
Main Methods:
- Comprehensive literature search of Cochrane Stroke Group Trials Register, MEDLINE, and EMBASE up to October 2008.
- Inclusion of 26 randomized trials involving 7152 patients, comparing thrombolytic agents (urokinase, streptokinase, rt-PA, etc.) with control.
- Data extraction and quality assessment by two reviewers, with verification from principal investigators.
Main Results:
- Thrombolytic therapy, primarily within six hours of stroke onset, significantly reduced death or dependency at 3-6 months (OR 0.81, 95% CI 0.73-0.90).
- Treatment increased the risk of symptomatic intracranial hemorrhage (OR 3.49, 95% CI 2.81-4.33) and death (OR 1.31, 95% CI 1.14-1.50).
- Treatment within three hours showed greater efficacy in reducing death/dependency (OR 0.71, 95% CI 0.52-0.96) with no significant increase in mortality.
Conclusions:
- Thrombolytic therapy offers a significant net benefit by reducing the proportion of patients who are dead or dependent.
- The overall benefit is observed despite an increased risk of symptomatic intracranial hemorrhage and mortality.
- Further research is required to identify optimal patient selection and treatment protocols for routine clinical practice.
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