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Data from the Cochrane meta-analysis and a recent combined analysis of thrombolysis studies are considered in this section. The important individual study publications are considered in separate sections.
Cochrane Thrombolysis Meta-Analysis
The ongoing meta-analysis of thrombolysis trials can be found in the Cochrane Library.
The latest version shows a clear advantage in favour of thrombolytic therapy and especially rt-PA treatment.
However, the power of this analysis comes from the rt-PA trials and especially from the NINDS trial. The
Cochrane analysis also shows that there is a uniform trend to a 3 to 3.5 fold higher symptomatic haemorrhagic
transformation rate. However, this has to be seen in context against the short-time outcome achieved with not
treating acute ischaemic stroke, e.g. cerebral oedema.
PubMed Abstract
References:
NINDS Investigators. N Engl J Med 1995; 333 (24): 1581-1587.
Wardlaw et al. Cochrane Database Syst Rev 2002; 2: CD000213
NINDS-ECASS-ATLANTIS Combined Analysis
Combined Analysis of NINDS, ECASS 1+II, ATLANTIS*
N = 2776; Outcome: OR to reach mRS 0-1
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Time Interval |
N |
OR |
(95 % CI) |
Sign |
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0-90 |
311 |
2.83 |
(95 % CI) |
** |
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91-180 |
618 |
1.53 |
(1.11, 2.11) |
* |
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181-270 |
801 |
1.40 |
(1.06, 1.85) |
* |
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271-360 |
1046 |
1.16 |
(0.91, 1.49) |
- |
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The investigators of NINDS, ECASS and ATLANTIS have combined their data for a pooled analysis.
This analysis was presented for the first time in 2002; the publication is on its way. This is the first analysis
to look at effects of timing on outcome. The interesting findings are that the outcome in patients treated early
(in the first 90 minutes) is extremely improved. There is not such a difference between the second and the third
90-minute interval. However, beyond 4½ hours the effect may no longer be evident. Certainly statistical
significant is lost although this may be simply a reflection of lack of statistical power to detect a benefit
beyond 4½ hours.
PubMed Abstract
Reference:
Brott et al. 27th International Stroke Conference 2002; abstract.
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© 2005 Boehringer Ingelheim GmbH, Germany. All rights reserved.
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