Evidence supporting the use of thrombolysis for selected stroke patients with unknown time of onset has been strengthened with data from a new individual patient meta-analysis.
The meta-analysis combined data from four clinical trials that included a total of 483 patients with stroke of unknown time of onset. MRI or CT-perfusion imaging was used to identify those patients with salvageable brain tissue. They had been randomly assigned to receive either thrombolysis with intravenous tissue plasminogen activator (tPA, alteplase) or placebo/standard of care.
Results showed that use of intravenous alteplase resulted in better functional outcome, as measured on Modified Rankin Scale (mRS), at 90 days. Although there was an increase in risk for symptomatic intracranial hemorrhage and more deaths occurred among patients treated with alteplase than placebo, there were fewer cases of severe disability or death.
Dr Götz Thomalla
The new data were presented by Götz Thomalla, MD, University Medical Center Hamburg, Germany, at the European Stroke Organisation–World Stroke Organization (ESO-WSO) Conference 2020 on November 8. They were also simultaneously published online in The Lancet.
"These results provide level 1a evidence for the use of MRI or CT-perfusion imaging to guide treatment with intravenous alteplase in unknown onset stroke," Thomalla concluded.
He explained to
