التفاصيل البيبلوغرافية
| العنوان: |
Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data |
| المؤلفون: |
Thomalla, Gotz, Boutitie, Florent, Cheng, Bastian, Churilov, Leonid, Ebinger, Martin, Endres, Matthias, Fiebach, Jochen B., Fukuda-Doi, Mayumi, Inoue, Manabu, Kleinig, Timothy J., Latour, Lawrence L., Lemmens, Robin, Ma, Henry, Levi, Christopher R., Leys, D, Miwa, K, Molina, CA, Muir, KW, Nighoghossian, N, Parsons, MW, Pedraza, S, Schellinger, PD, Schwab, S, Koga, Masatoshi, Simonsen, CZ, Song, SS, Thijs, V, Toni, D, Hsu, CY, Wahlgren, N, Yamamoto, H, Yassi, N, Yoshimura, S, Warach, S, Ringleb, Peter, Hacke, W, Toyoda, K, Donnan, GA, Davis, SM, Gerloff, C, Acosta, BR, Aegidius, K, Albiker, C, Alegiani, A, Almendrote, M, Schwamm, Lee H., Alonso, A, Althaus, K, Amarenco, P, Amiri, H, Anders, B, Aniculaesei, A, Appleton, J, Arenillas, J, Back, C, Bähr, C, Wu, Ona, Bardutzky, J, Baronnet-Chauvet, F, Bathe-Peters, R, Bayer-Karpinska, A, Becerra, JL, Beck, C, Belchí Guillamon, O, Benoit, A, Berhoune, N, Bindila, D, Bendszus, Martin, Birchenall, J, Blanc-Lasserre, K, Blanco Gonzales, M, Bobinger, T, Bodechtel, U, Bodiguel, E, Bojaryn, U, Bonnet, L, Bouamra, B, Bourgeois, P, Bladin, Christopher F., Breuer, L, Breynaert, L, Broughton, D, Brouns, R, Brugirard, S, Bruneel, B, Buggle, F, Cakmak, S, Calleja, A, Calvet, D, Campbell, Bruce C. V., Carrera, D, Chen, HC, Cheripelli, B, Cho, TH, Choe, CU, Choy, L, Christensen, H, Ciatipis, M, Cloud, G, Cogez, J |
| المساهمون: |
The University of Newcastle. Faculty of Health & Medicine, School of Medicine and Public Health |
| بيانات النشر: |
The Lancet Publishing Group |
| سنة النشر: |
2020 |
| المجموعة: |
NOVA: The University of Newcastle Research Online (Australia) |
| مصطلحات موضوعية: |
patients, intravenous alteplase, imaging biomarkers, stroke, SDG 3, Sustainable Development Goals |
| الوصف: |
Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score ... |
| نوع الوثيقة: |
article in journal/newspaper |
| اللغة: |
English |
| تدمد: |
0140-6736 |
| العلاقة: |
NHMRC; The Lancet Vol. 396, Issue 10262, p. 1574-1584; http://hdl.handle.net/1959.13/1441953Test; uon:41586 |
| الإتاحة: |
http://hdl.handle.net/1959.13/1441953Test |
| رقم الانضمام: |
edsbas.D8E5F2D1 |
| قاعدة البيانات: |
BASE |
