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Goh S, Tan NHW, Tan CH, et al. Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis. J Thromb Thrombolysis. 2021;doi: 10.1007/s11239-021-02531-2.
Goh, S., Tan, N. H. W., Tan, C. H., Leow, A. S. T., Sia, C. H., Ho, A. F. W., Lim, M. J. R., Yeo, L. L. L., & Tan, B. Y. Q. (2021). Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis. Journal of thrombosis and thrombolysis, . https://doi.org/10.1007/s11239-021-02531-2
Goh, Sherill, et al. "Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis." Journal of thrombosis and thrombolysis vol. (2021). doi: https://doi.org/10.1007/s11239-021-02531-2
Goh S, Tan NHW, Tan CH, Leow AST, Sia CH, Ho AFW, Lim MJR, Yeo LLL, Tan BYQ. Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis. J Thromb Thrombolysis. 2021 Jul 24; doi: 10.1007/s11239-021-02531-2. Epub 2021 Jul 24. PMID: 34302590.
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J Thromb Thrombolysis. 2021 Jul 24; doi: 10.1007/s11239-021-02531-2. Epub 2021 Jul 24.

Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis.

Journal of thrombosis and thrombolysis

Sherill Goh, Natalie H W Tan, Choon Han Tan, Aloysius S T Leow, Ching-Hui Sia, Andrew F W Ho, Mervyn J R Lim, Leonard L L Yeo, Benjamin Y Q Tan

Affiliations

  1. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  2. Department of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
  3. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
  4. Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.
  5. Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
  6. Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore.
  7. Division of Neurosurgery, Department of General Surgery, National University Hospital, Singapore, Singapore.
  8. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].
  9. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore. [email protected].

PMID: 34302590 DOI: 10.1007/s11239-021-02531-2

Abstract

Previous intracerebral hemorrhage (ICH) is labelled as a contraindication for the use of intravenous tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS) based on expert opinion. However, there is a paucity of data available regarding the benefits and risks of IV-tPA in this population. Recent small retrospective cohort studies reporting its off-label use suggest it may be beneficial. This study aims to investigate the safety and efficacy of IV-tPA in AIS patients with previous ICH. We performed a systematic review and meta-analysis of studies reporting on IV-tPA use in AIS patients with and without previous ICH. We searched Embase, PubMed and Cochrane Library from inception to 20 April 2021. Outcomes measured included symptomatic ICH (sICH), 3-month modified Rankin Scale (mRS) score, and 3-month mortality. We included seven retrospective cohort studies comprising 5760 AIS patients who had received IV-tPA, of which 134 had previous ICH. There was no significant difference in the odds of sICH (OR 1.57, 95% CI 0.78-3.15, p = 0.21) and 3-month mRS (mRS 0-1: OR 0.78, 95% CI 0.37-1.65, p = 0.52; mRS 0-2: OR 1.07, 95% CI 0.36-3.15, p = 0.90) between patients with and without previous ICH. There was a trend towards higher 3-month mortality in patients with previous ICH (OR 1.69, 95% CI 0.98-2.91, p = 0.06), although this did not reach statistical significance. The use of IV-tPA in AIS patients with previous ICH was not associated with an increased risk of sICH or disability at 3 months. Further larger studies are needed to establish the safety and efficacy of IV-tPA use in this population.

© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords: Acute ischemic stroke; Cerebrovascular accident; Intracerebral hemorrhage; Intravenous thrombolysis; Meta-analysis; Systematic review

References

  1. Feigin VL, Norrving B, Mensah GA (2017) Global burden of stroke. Circ Res 120(3):439–448 - PubMed
  2. Barber P et al (2001) Why are stroke patients excluded from TPA therapy?: an analysis of patient eligibility. Neurology 56(8):1015–1020 - PubMed
  3. Disorders, N.I.o.N. and S.r.-P.S.S. Group (1995) Tissue plasminogen activator for acute ischemic stroke. New Engl J Med 333(24):1581–1588 - PubMed
  4. Hacke W et al (1995) Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 274(13):1017–1025 - PubMed
  5. Hacke W et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 352(9136):1245–1251 - PubMed
  6. Albers GW et al (2002) Atlantis trial. Stroke 33(2):493–496 - PubMed
  7. ATLANTIS, T. (2004) Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363(9411):768–774 - PubMed
  8. Group I.-C. (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379(9834):2352–2363 - PubMed
  9. Tong D (2011) Are all IV thrombolysis exclusion criteria necessary?: Being SMART about evidence-based medicine. Neurology 76:1780 - PubMed
  10. De Keyser J et al (2007) Intravenous alteplase for stroke: beyond the guidelines and in particular clinical situations. Stroke 38(9):2612–2618 - PubMed
  11. Jauch EC et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44(3):870–947 - PubMed
  12. Steiner T et al (2014) European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke 9(7):840–855 - PubMed
  13. Green T (2011) Canadian stroke best practices update 2010. Can J Neurosci Nurs 33(1):4–5 - PubMed
  14. Powers WJ et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 50(12):e344–e418 - PubMed
  15. AbdelRazek M et al (2016) Prior asymptomatic parenchymal hemorrhage does not increase the risk for intracranial hemorrhage after intravenous thrombolysis. Stroke 40:201–204 - PubMed
  16. Aoki J et al (2014) Risk of intracerebral hemorrhage after thrombolysis in patients with asymptomatic hemorrhage on T2*. Cerebrovasc Dis 38(2):107–116 - PubMed
  17. Chi MS, Chan LY (2017) Thrombolytic therapy in acute ischemic stroke in patients not fulfilling conventional criteria. Neurologist 22(6):219–226 - PubMed
  18. Lee SH et al (2016) Should we exclude acute stroke patients with previous intracerebral hemorrhage from receiving intravenous thrombolysis? Int J Stroke 11(7):783–790 - PubMed
  19. Meretoja A et al (2010) Off-label thrombolysis is not associated with poor outcome in patients with stroke. Stroke 41(7):1450–1458 - PubMed
  20. Zand R et al (2018) Safety of intravenous thrombolysis in chronic intracranial hemorrhage: a five-year multicenter study. J Stroke Cerebrovasc Dis 27(3):620–624 - PubMed
  21. Zhao GJ et al (2019) The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage. Braz J Med Biol Res 52(2):7739 - PubMed
  22. Peterson J et al (2011) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute, Ottawa - PubMed
  23. Charidimou A, Shoamanesh A, Initiative IM-M (2016) Clinical relevance of microbleeds in acute stroke thrombolysis: comprehensive meta-analysis. Neurology 87(15):1534–1541 - PubMed
  24. Charidimou A et al (2017) Microbleeds, cerebral hemorrhage, and functional outcome after stroke thrombolysis: individual patient data meta-analysis. Stroke 48(8):2084–2090 - PubMed
  25. Tsivgoulis G et al (2016) Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden: a meta-analysis. JAMA Neurol 73(6):675–683 - PubMed
  26. Wang S et al (2017) The impact of cerebral microbleeds on intracerebral hemorrhage and poor functional outcome of acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis. J Neurol 264(7):1309–1319 - PubMed
  27. Zand R et al (2017) Cerebral microbleeds and risk of intracerebral hemorrhage post intravenous thrombolysis. J Stroke Cerebrovasc Dis 26(3):538–544 - PubMed
  28. Yaghi S et al (2017) Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 48(12):e343–e361 - PubMed
  29. Robinson TG et al (2017) Low- versus standard-dose alteplase in patients on prior antiplatelet therapy: the ENCHANTED Trial (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Stroke 48(7):1877–1883 - PubMed
  30. Anderson CS et al (2019) Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet 393(10174):877–888 - PubMed

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