on May 28, 2009
Published online before print May 28, 2009, doi: 10.1161/STROKEAHA.109.552547
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Submitted on March 14, 2009
From the Stanford Stroke Center (M.G.L.), Stanford University Medical Center, Palo Alto, Calif; the Department of Neurology (V.N.T.), University Hospitals of Leuven, Belgium; the Vesalius Research Center (V.N.T.), Leuven, Belgium; and Boehringer Ingelheim Pharma GmbH & Co (E.B.), Germany. * To whom correspondence should be addressed. E-mail: lansberg{at}stanford.edu.
Background and Purpose—The Third European Cooperative Acute Stroke Study (ECASS-3) demonstrated a benefit of treatment with intravenous tissue plasminogen activator (tPA) for acute stroke in the 3- to 4.5-hour time-window. Prior studies, however, have failed to demonstrate a significant benefit of tPA for patients treated beyond 3 hours. The purpose of this study was to produce reliable and precise estimates of the treatment effect of tPA by pooling data from all relevant studies. Methods—A metaanalysis was undertaken to determine the efficacy of tPA in the 3- to 4.5-hour time-window. The effect of tPA on favorable outcome and mortality was assessed. Results—The metaanalysis included data from patients treated in the 3- to 4.5-hour time-window in ECASS-1 (n=234), ECASS-2 (n=265), ECASS-3 (n=821) and The Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) (n=302). tPA treatment was associated with an increased chance of favorable outcome (odds ratio 1.31; 95% CI: 1.10 to 1.56; P=0.002) and no significant difference in mortality (odds ratio 1.04; 95% CI: 0.75 to 1.43; P=0.83) compared to placebo treated patients. Conclusions—Treatment with tPA in the 3- to 4.5-hour time-window is beneficial. It results in an increased rate of favorable outcome without adversely affecting mortality.
Revised on April 24, 2009
Accepted on April 27, 2009
Efficacy and Safety of Tissue Plasminogen Activator 3- to 4.5-Hours After Acute Ischemic Stroke. A Metaanalysis
Maarten G. Lansberg MD, PhD*;
Key words: acute stroke • thrombolysis • metaanalysis