A comparison of low- versus standard-dose bridging alteplase in acute ischemic stroke mechanical thrombectomy using indirect methods

医学 溶栓 改良兰金量表 优势比 桥接(联网) 冲程(发动机) 随机对照试验 脑出血 临床试验 血管内治疗 外科 缺血性中风 内科学 麻醉 蛛网膜下腔出血 缺血 动脉瘤 心肌梗塞 计算机网络 工程类 机械工程 计算机科学
作者
Wei Zheng,Hanhan Lei,Gareth Ambler,David J. Werring,Huiying Lin,Xiaojuan Lin,Yi Tang,Jing Wu,Zhao‐Min Lin,Nan Liu,Houwei Du
出处
期刊:Therapeutic Advances in Neurological Disorders [SAGE Publishing]
卷期号:16: 175628642211448-175628642211448 被引量:1
标识
DOI:10.1177/17562864221144806
摘要

Background: Whether low-dose alteplase is similar to standard-dose bridging alteplase prior to endovascular mechanical thrombectomy in patients with acute ischemic stroke (AIS) remains uncertain. Aims: The aim of this study was to compare the efficacy and safety outcomes of low- versus standard-dose bridging alteplase therapy (BT) in patients with acute ischemic stroke (AIS) who are eligible for intravenous thrombolysis (IVT) within 4.5 h after onset. Methods: We conducted an indirect comparison of low- versus standard-dose bridging alteplase before mechanical thrombectomy in AIS of current available clinical randomized controlled trials (RCTs) that compared direct mechanical thrombectomy treatment (dMT) to BT. Primary efficacy outcomes were functional independence and excellent recovery defined as a dichotomized modified Rankin Scale (mRS) 0–2 and 0–1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and any intracranial hemorrhage (ICH). Results: We included six RCTs of 2334 AIS patients in this analysis, including one trial using low-dose bridging alteplase ( n = 103) and five trials using standard-dose bridging alteplase ( n = 1067) against a common comparator (dMT). Indirect comparisons of low- to standard-dose bridging alteplase yielded an odds ratio (OR) of 0.84 (95% CI 0.47–1.50) for 90-day mRS 0–2, 1.18 (95% CI 0.65–2.12) for 90-day mRS 0–1, 1.21 (95% CI 0.44–3.36) for mortality, and 1.11 (95% CI 0.39–3.14) for successful recanalization. There were no significant differences in the odds for sICH (OR 1.05, 95% CI 0.32–3.41) or any ICH (OR 1.71, 95% CI 0.94–3.10) between low- and standard-dose bridging alteplase. Conclusion: Indirect evidence shows that the effects of low- and standard-dose bridging alteplase are similar for key efficacy and safety outcomes. Due to the wide confidence intervals, larger randomized trials comparing low- and standard-dose alteplase bridging therapy are required.

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