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Current status of intravenous tissue plasminogen activator dosage for acute ischaemic stroke: an updated systematic review.
| Content Provider | Europe PMC |
|---|---|
| Author | Wang, Xia You, Shoujiang Sato, Shoichiro Yang, Jie Carcel, Cheryl Zheng, Danni Yoshimura, Sohei Anderson, Craig S Sandset, Else Charlotte Robinson, Thompson Chalmers, John Sharma, Vijay K |
| Copyright Year | 2018 |
| Abstract | The optimal dose of recombinant tissue plasminogen activator (rtPA) for acute ischaemic stroke (AIS) remains controversial, especially in Asian countries. We aimed to update the evidence regarding the use of low-dose versus standard-dose rtPA. We performed a systematic literature search across MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to 22 August 2016 to identify all related studies. The outcomes were death or disability (defined by modified Rankin Scale 2–6), death, and symptomatic intracerebral haemorrhage (sICH). Where possible, data were pooled for meta-analysis with ORs and corresponding 95% CIs by means of random-effects or fixed-effects meta-analysis. We included 26 observational studies and 1 randomised controlled trial with a total of 23 210 patients. Variable doses of rtPA were used for thrombolysis of AIS in Asia. Meta-analysis shows that low-dose rtPA was not associated with increased risk of death or disability (OR 1.13, 95% CI 0.95 to 1.33), or death (OR 0.86, 95% CI 0.74 to 1.01), or decreased risk of sICH (OR 1.06, 95% CI 0.65 to 1.72). The results remained consistent when sensitivity analyses were performed including only low-dose and standard-dose rtPA or only Asian studies. Our review shows small difference between the outcomes or the risk profile in the studies using low-dose and/or standard-dose rtPA for AIS. Low-dose rtPA was not associated with lower risk of death or disability, death alone, or sICH. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5870642&blobtype=pdf |
| Journal | Stroke and Vascular Neurology [Stroke Vasc Neurol] |
| Volume Number | 3 |
| DOI | 10.1136/svn-2017-000112 |
| PubMed Central reference number | PMC5870642 |
| Issue Number | 1 |
| PubMed reference number | 29600005 |
| e-ISSN | 20598696 |
| Language | English |
| Publisher | BMJ Publishing Group |
| Publisher Date | 2018-01-13 |
| Publisher Place | BMA House, Tavistock Square, London, WC1H 9JR |
| Access Restriction | Open |
| Rights License | This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. |
| Subject Keyword | acute ischemic stroke Asian low-dose tissue plasminogen activator thrombolysis |
| Content Type | Text |
| Resource Type | Article |
| Subject | Cardiology and Cardiovascular Medicine Neurology (clinical) |
