Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

Jonathan Emberson; Kennedy R. Lees; Patrick D. Lyden; Lisa Blackwell; Gregory W. Albers; Erich Bluhmki; Thomas Brott; Geoff Cohen; Stephen C. Davis; Geoffrey A. Donnan; James C. Grotta; George Howard; Markku Kaste; Masatoshi Koga; Ruediger von Kummer; Maarten G. Lansberg; Richard I. Lindley; Gordon Murray; Jean‐Marc Olivot; Mark Parsons; Barbara C. Tilley; Danilo Toni; Ḱazunori Toyoda; Nils Wahlgren; Joanna M. Wardlaw; William Whiteley; Gregory J. del Zoppo; Colin Baigent; Peter Sandercock; Werner Hacke

doi:10.1016/s0140-6736(14)60584-5

Key Points

To determine how treatment delay, patient age, and baseline stroke severity alter the therapeutic efficacy and safety of intravenous alteplase in acute ischaemic stroke.
Individual patient data meta-analysis pooling participant-level records from randomised controlled trials comparing intravenous alteplase against control.
Analyzed clinical outcomes stratified by time from stroke onset to treatment, baseline stroke severity, and age groups.
Earlier administration of intravenous alteplase yields substantially greater functional recovery, with therapeutic benefit diminishing steadily as treatment delay increases.
Net clinical benefits of alteplase extend across a wide spectrum of patient ages and initial stroke severity levels when administered promptly.

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Implication

Randomized trial meta-analysis reveals how treatment delay, age, and stroke severity modulate alteplase efficacy in acute ischaemic stroke, highlighting the critical value of rapid intervention.

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Emberson et al. (2014) studied this question.

synapsesocial.com/papers/69d6bcf7e328128020aa8287 https://doi.org/10.1016/s0140-6736(14)60584-5

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Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

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Discussion

Cite This Study

Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

Key Points

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Implication

Abstract

Discussion

Cite This Study

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