Efficacy and safety of tissue plasminogen activator 3 to 4.5 hours after acute ischemic stroke: a metaanalysis.
Efficacy and safety of tissue plasminogen activator 3 to 4.5 hours after acute ischemic stroke: a metaanalysis.
复制标题
DOI：
10.1161/strokeaha.109.552547
复制
发表时间：
2009-07
期刊：
影响因子：
8.3
通讯作者：
Thijs VN
中科院分区：
文献类型：
--
作者：
Lansberg MG;Bluhmki E;Thijs VN
ECASS-3 研究证明了在 3-4.5 小时时间窗口内静脉注射 tPA 治疗急性卒中的益处。然而，之前的研究未能证明 tPA 对治疗超过 3 小时的患者有显着益处。本研究的目的是通过汇集所有相关研究的数据，对 tPA 的治疗效果进行可靠且精确的估计。进行荟萃分析以确定 tPA 在 3-4.5 小时时间窗口内的功效。评估了 tPA 对良好结局和死亡率的影响。荟萃分析包括 ECASS-1 (n=234)、ECASS-2 (n=265)、ECASS-3 (n=821) 和 ATLANTIS (n=302) 中 3-4.5 小时时间窗口内接受治疗的患者的数据。与安慰剂治疗的患者相比，tPA 治疗与良好结局的机会增加相关（OR 1.31，95% CI 1.10-1.56；p=0.002），但死亡率无显着差异（OR 1.04；95% CI 0.75-1.43；p=0.83）。在 3-4.5 小时的时间窗口内使用 tPA 治疗是有益的。它会增加有利结果的发生率，而不会对死亡率产生不利影响。
The ECASS-3 study demonstrated a benefit of treatment with intravenous tPA for acute stroke in the 3-4.5 hour time-window. Prior studies, however, have failed to demonstrate a significant benefit of tPA for patients treated beyond 3 hours. The purpose of this study was to produce reliable and precise estimates of the treatment effect of tPA by pooling data from all relevant studies. A meta-analysis was undertaken to determine the efficacy of tPA in the 3-4.5 hour time-window. The effect of tPA on favorable outcome and mortality was assessed. The meta-analysis included data from patients treated in the 3-4.5 hour time-window in ECASS-1 (n=234), ECASS-2 (n=265), ECASS-3 (n=821) and ATLANTIS (n=302). tPA treatment was associated with an increased chance of favorable outcome (OR 1.31, 95% CI 1.10-1.56; p=0.002) and no significant difference in mortality (OR 1.04; 95% CI 0.75-1.43; p=0.83) compared to placebo treated patients. Treatment with tPA in the 3-4.5 hour time-window is beneficial. It results in an increased rate of favorable outcome without adversely affecting mortality.