Thrombolysis (different doses, routes of administration and agents) for acute ischaemic stroke, an update of the evidence since the last Cochrane review.
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- Background: Ischaemic stroke is a leading cause of death and disability. Thrombolysis is the mainstay of treatment in the acute setting. A Cochrane review on the different thrombolytic agents, doses and routes of administration was last updated in 2003.
- Methods: The Cochrane Stroke Group trials register was searched as well as the MEDLINE and EMBASE Databases from July 2003 to Dec 2010. Randomised or quasi-randomised trials of different doses of a thrombolytic agent, different drugs or different routes of administration of the same agent in acute stroke.
- Results: Eight new studies have been completed and published since the previous review and fulfil the selection criteria. One study compares two different doses of tPA, three studies compare different doses of desmoteplase and one study different doses of tenecteplase. Three studies compare intra-arterial versus intravenous administration of thrombolysis. There were more haemorrhages in the high dose group and that was statistically significant (OR 3.09, 95% CI 1.36 to 7.00). There was no difference between the higher and the lower dose groups in terms of death or disability at the end of follow up (OR 0.93, 95% CI 0.66 to 1.30). Lower dose of desmoteplase seems to be associated with fewer deaths at the end of the follow up (OR 3.21, 95% CI 1.23 to 8.39). No other significant differences were identified between different doses of the same agent, between different agents or between intra-arterial and intravenous treatment.
- Conclusion: The evidence remains inadequate to conclude what is the optimal thrombolytic regimen in acute stroke. The scant data may suggest that higher doses of thrombolytic agent lead to higher incidence of intracranial haemorrhage.
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