Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy
| Autor: | Martina Goeldlin, Tomas Dobrocky, David J. Seiffge, Daniel Strbian, Marcel Arnold, Pasquale Mordasini, Urs Fischer, Marc Soudant, Manon Kappelhof, Jan Gralla, Syed F Zaidi, Diederik W.J. Dippel, Osama O. Zaidat, Thomas Raphael Meinel, Nils Mueller-Kronast, Pascal J. Mosimann, Alicia C. Castonguay, Johannes Kaesmacher, Michael D. Hill, Daniel M. Heiferman, William W. Ashley, Mayank Goyal, Christoph C. Kurmann, Alejandro M Spiotta, Mohammad Anadani, Serge Bracard, Eike I. Piechowiak |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
thrombolysis
medicine.medical_specialty medicine.medical_treatment MEDLINE 610 Medicine & health 030204 cardiovascular system & hematology Brain Ischemia 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Modified Rankin Scale Internal medicine medicine Humans Thrombolytic Therapy Stroke Ischemic Stroke Urokinase business.industry General Medicine Thrombolysis medicine.disease stroke 3. Good health Treatment Outcome thrombectomy Tissue Plasminogen Activator Meta-analysis Surgery Observational study Neurology (clinical) business 030217 neurology & neurosurgery medicine.drug Cohort study |
| Zdroj: | Journal of Neurointerventional Surgery Kaesmacher, Johannes; Meinel, Thomas Raphael; Kurmann, Christoph; Zaidat, Osama O; Castonguay, Alicia C; Zaidi, Syed F; Mueller-Kronast, Nils; Kappelhof, Manon; Dippel, Diederik W J; Soudant, Marc; Bracard, Serge; Hill, Michael D; Goyal, Mayank; Strbian, Daniel; Heiferman, Daniel M; Ashley, William; Anadani, Mohammad; Spiotta, Alejandro M; Dobrocky, Tomas; Piechowiak, Eike I.; ... (2021). Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data. Journal of neurointerventional surgery, 13(12), pp. 1073-1080. BMJ Publishing Group 10.1136/neurintsurg-2020-016680 |
| ISSN: | 1759-8478 |
| Popis: | BackgroundAchieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse.MethodsWe performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin Scale ≤2, mortality at 90 days).ResultsThe search identified six observational cohort studies and three observational datasets of MT randomized-controlled trial data reporting on IA fibrinolytics with MT as compared with MT alone, including 2797 patients (405 with additional IA fibrinolytics (100 urokinase (uPA), 305 tissue plasminogen activator (tPA)) and 2392 patients without IA fibrinolytics). Of 405 MT patients treated with additional IA fibrinolytics, 209 (51.6%) received prior intravenous tPA. We did not observe an increased risk of sICH after administration of IA fibrinolytics as adjunct to MT (OR 1.06, 95% CI 0.64 to 1.76), nor excess mortality (0.81, 95% CI 0.60 to 1.08). Although the mode of reporting was heterogeneous, some studies observed improved reperfusion after IA fibrinolytics.ConclusionThe quality of evidence regarding peri-interventional administration of IA fibrinolytics in MT is low and limited to observational data. In highly selected patients, no increase in sICH was observed, but there is large uncertainty. |
| Databáze: | OpenAIRE |
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