Comparative Efficacy and Safety on Treatment of Acute Ischemic Stroke beyond Alteplase: A Network Meta-analysis of Randomized Controlled Trials
Date Issued
2012
Date
2012
Author(s)
Kuo, Mu-Yi
Abstract
英文摘要
Background
Alteplase is the only FDA-approved treatment for patients with acute ischemic stroke within 3 hours of onset; however, most of the patients are not qualified for the treatment due to late presentation. We did a network meta-analysis of randomized controlled trials to collect current available treatments, including recanalization and neuroprotection, for comparisons efficacy and treatment between different treatments.
Materials and Methods
We conducted a systematic review to collect randomized controlled trials of different treatment of acute ischemic stroke from electronic databases of MEDLINE, PubMED and Cochrane Central Register of Clinical Trials during January 2001 to February 2012. Outcomes for inclusion were mRS, NIHSS and Barthel Index after 3 months of treatment and incidences of mortality and ICH.
Results
A total of 18 studies were included in the review. In the outcome of mRS after 3 months of treatment, sonothrombolysis and focal hypothermia plus alteplase had the best beneficial effect for functional recovery. Tirofiban and erythromycin were the least beneficial treatment among all the treatments. DP-b99 is the best to reduce neurological deficits than sonothrombolysis and focal hypothermia plus alteplase evaluated by NIHSS. Focal hypothermia plus alteplase was better than other treatments by outcomes of Barthel Index. In risk of mortality, tirofiban and DP-b99 had the lowest risk of mortality while desmoteplase and erythromycin carried the highest risk of morality, which were followed by sonothrombolysis and focal hypothermia plus alteplase. In risk of ICH, treatment with sonothrombolysis and focal hypothermia plus alteplase had the highest risk, while treatment with albumin and laser therapy had the lowest risk. In the overall evaluation of different outcomes, treatments best in functional outcome had high risks of mortality and ICH; treatments in low risk of mortality and ICH showed little benefit in functional outcome. Only treatments with DP-b99, laser therapy and tenecteplase showed a moderate balance in efficacy and safety.
Conclusion
No treatment currently available for acute ischemic stroke except alteplase is both safe and efficacious. Whether neuroprotection should be used alone or combined with recanalization remained undetermined. Further investigation for the treatment of acute ischemic stroke is warranted in order to provide effective and safety treatment for those who are not qualified for alteplase.
Subjects
Ischemic stroke
alteplase
recombinant tissue plasminogen activators
recanalization
neuroprotection
sonothrombolysis
Type
thesis
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