Optimized timing of thrombolytic therapy for the treatment of stroke: a rapid review
Schaink A
Record ID 32014001033
English
Authors' objectives:
The objective of this analysis is to determine the optimal timing for the administration of thrombolytic therapy for stroke to maximize patient independence and minimize the risk of symptomatic intracranial hemorrhage (SICH).
Authors' recommendations:
Two meta-analyses were identified that examined the optimal timing of thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). After assessment of methodological quality, and overlap between the articles, one meta-analysis—by Wardlaw et al—was selected.
Treatment with rt-PA within 0 to 3 hours after stroke onset was significantly better than treatment within 3 to 6 hours (which was not statistically significant), and led to an increased number of patients who were alive and independent at 90 days. (GRADE quality of evidence: moderate)
There was a significant increase in risk of symptomatic intracranial hemorrhage within 7 days of treatment for patients who received rt-PA both 0 to 3 hours and 3 to 6 hours after stroke onset, with no significant difference between time windows. The significant functional benefit at 90 days observed in those treated within 0 to 3 hours occurred despite this initial increase in risk of hemorrhage. (GRADE quality of evidence: moderate)
Given the lack of evidence to support improved outcomes, coupled with the risk of intracerebral hemorrhage for patients receiving rt-PA more than 3 hours after stroke onset, the use of this intervention cannot be recommended for these patients.
Details
Project Status:
Completed
Year Published:
2013
URL for published report:
http://www.hqontario.ca/Portals/0/Documents/eds/rapid-reviews/thrombolytics-timing-stroke-130117-en.pdf
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
Canada
MeSH Terms
- Thrombolytic Therapy
- Time Factors
- Stroke
Contact
Organisation Name:
Health Quality Ontario
Contact Address:
Evidence Development and Standards, Health Quality Ontario, 130 Bloor Street West, 10th floor, Toronto, Ontario Canada M5S 1N5
Contact Name:
EDSinfo@hqontario.ca
Contact Email:
OH-HQO_hta-reg@ontariohealth.ca
Copyright:
Health Quality Ontario
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.