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Updated: Jun 18, 2026

Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Mismatch-based delayed thrombolysis: a meta-analysis.

Nishant K Mishra1, Gregory W Albers, Stephen M Davis

  • 1University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary and Faculty of Medicine, University of Glasgow, Glasgow G116NT, UK.

Stroke
|November 21, 2009
PubMed
Summary
This summary is machine-generated.

Delayed thrombolysis in stroke patients selected by mismatch imaging improves reperfusion but does not significantly improve clinical outcomes. This treatment carries risks of hemorrhage and mortality, requiring further validation before routine use.

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Last Updated: Jun 18, 2026

Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Area of Science:

  • Neuroscience
  • Radiology
  • Emergency Medicine

Background:

  • Clinical benefit of thrombolysis diminishes with increased stroke onset to treatment time.
  • Mismatch imaging shows promise for selecting patients for delayed thrombolysis.
  • Previous studies used mismatch criteria in case series and clinical trials.

Purpose of the Study:

  • To meta-analyze existing trials on delayed thrombolysis in mismatch-selected stroke patients.
  • To evaluate the evidence supporting extended thrombolysis treatment windows.
  • To assess outcomes, reperfusion rates, mortality, and hemorrhage risks.

Main Methods:

  • Systematic search of Web of Knowledge for relevant thrombolysis trials.
  • Inclusion of patients treated beyond 3 hours with mismatch imaging.
  • Comparison of outcomes (favorable outcome, reperfusion, mortality, hemorrhage) between thrombolyzed and non-thrombolyzed groups.
  • Calculation of adjusted odds ratios (a-ORs) with 95% CIs and heterogeneity assessment.

Main Results:

  • Meta-analysis included 502 mismatch patients from DIAS, DIAS II, DEDAS, DEFUSE, and EPITHET trials.
  • Successful reperfusion significantly increased favorable outcomes (a-OR=5.2).
  • Thrombolysis did not significantly improve overall favorable clinical outcome (a-OR=1.3).
  • Reperfusion/recanalization rates were higher with thrombolysis (a-OR=3.0).
  • Thrombolysis showed increased mortality (a-OR=2.4) and symptomatic intracerebral hemorrhage (a-OR=6.5), though not always significant after excluding abandoned desmoteplase doses.

Conclusions:

  • Delayed thrombolysis in mismatch patients increases reperfusion/recanalization, which is linked to better outcomes.
  • Clinical outcome improvement was not confirmed, but potential benefit remains.
  • Significant risks of symptomatic intracerebral hemorrhage and possible increased mortality exist.
  • Mismatch criteria require further validation; delayed treatment is not recommended for routine care pending Phase III trial results.