Large Analysis Supports Thrombolysis for Stroke

By Larry Husten

Edited by Lorenzo Di Francesco, MD, FACP, FHM

A Lancet meta-analysis offers evidence that the use of thrombolysis should be more aggressively pursued across various subgroups of patients with ischemic stroke.

Researchers examined data from nine randomized trials testing alteplase against placebo or open control in nearly 6800 patients. Thrombolysis was more likely to lead to a good stroke outcome, defined as no significant disability at 3 to 6 months, in patients treated within 4.5 hours. In particular, for treatment within 3 hours, 33% of alteplase recipients versus 23% of controls had good outcomes.

The chief disadvantage to thrombolysis was an early increase in intracranial hemorrhage (ICH), with 2.7% of alteplase recipients and 0.4% of controls having a fatal ICH by day 7. This resulted in a significant increase in early mortality, which was no longer significant at day 90.

Benefit and risk did not vary based on age or stroke severity. Despite the early increase in mortality, the authors concluded that thrombolysis was associated with an average absolute increase in disability-free survival of approximately 10% among patients treated within 3 hours and 5% for those treated between 3 and 4.5 hours.