The rate of early neurological deterioration occurring after thrombolytic therapy: A meta‐analysis

OBJECTIVES: The rate of early neurological deterioration (END) occurring after thrombolytic therapy is controversial. To explore a more precise estimation of the rate, a meta-analysis was conducted in the present study. METHODS: The relevant studies were identified by searching PubMed, EMBASE, and Cochrane Collaboration Database up to June 2018. The definition of END was prespecified according to the most commonly used definition: ≥4-point increase in National Institutes of Health Stroke Scale between admission and 24 hr. The meta-analysis was performed by using the STATA 12. RESULTS: Eleven studies with a total of 3,539 subjects, including 373 patients with END and 3,166 patients without END, were collected. The pooled analysis showed that the rate of END occurring after thrombolytic therapy was about 11.0% (95% CI: 7.8%-14.3%). Subgroup analysis by continent showed that the rate of END occurring after thrombolytic therapy of patients in Asia (15.9%, 95% CI: 7.4%-24.5%) was higher than in Europe (7.6%, 95% CI: 4.9%-10.3%) and in North America (11.8%, 95% CI: 8.5%-15.0%). Subgroup analysis by onset to treatment time (OTT) displayed that the rate of END occurring after thrombolytic therapy was 5.4% (95% CI: 1.2%-9.5%), 15.6% (95% CI: 9.6%-21.5%), and 18.5% (95% CI: 11.2%-25.8%) for the patients whose OTT ≤120.0 min, from 120.1 to 179.9 min, from 180.0 to 270.0 min, respectively. CONCLUSION: The rate of END occurring after thrombolytic therapy is about 11.0%. This finding may provide a scientific reference for researchers to evaluate the efficacy and safety of thrombolytic therapy.