Evidence map›Paper›PMID 39469780›Full record

SynthesisAnnals of clinical and translational neurology2024

Safety and efficacy of intravenous thrombolytic therapy in the extended window up to 24 hours: A systematic review and meta-analysis.

Omar M Al-Janabi, Seyed Behnam Jazayeri, Michelle A Toruno, Yamama M Mahmood, Sherief Ghozy, Shadi Yaghi, Alejandro A Rabinstein, David F Kallmes

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of clinical and translational neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Review
  5. Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Omar M Al-Janabi *Department of Neurology, Baptist Health, Lexington, Kentucky, USA.ORCID 0000-0003-2208-4308
Seyed Behnam Jazayeri *Sina Trauma & Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Michelle A TorunoDepartment of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Yamama M MahmoodCenteral Pharmacy, University of Kentucky Healthcare, Lexington, Kentucky, USA.
Sherief GhozyDepartment of Radiology, Mayo Clinic, Rochester, Minnesota, USA.ORCID 0000-0001-5629-3023
Shadi YaghiDepartment of Neurology, Brown University, Providence, Rhode Island, USA.ORCID 0000-0003-0031-1004
Alejandro A RabinsteinDepartment of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
David F KallmesDepartment of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveAbout 25% of patients with acute ischemic stroke (AIS) present within the intravenous thrombolytic (IVT) therapeutic window of <4.5 h. This study is to elucidate the safety and efficacy of IVT in the extended therapeutic window (ETW) in patients with AIS.

methodsUsing PRISMA guidelines, a systematic review was conducted using PubMed, Embase, and Scopus. A rigorous risk of bias assessment was conducted using the RoB2 tool. Rates of excellent and good functional outcome (mRS 0-1 and mRS 0-2) at 90 days, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days were pooled using generalized linear mixed model and compared with controls. Meta-analyses were conducted employing random-effect models with risk ratio (RR) and 95% confidence intervals (CIs). Subgroup analysis was performed to assess the effect of imaging modalities used for patient selection.

resultsEight randomized controlled trials (n = 2221, 59% male) were included. At 90 days IVT showed higher rates of functional recovery: mRS 0-1: RR 1.21 95% CI 1.1-1.34, p < 0.001, and mRS 0-2: RR 1.11 95% CI 1.03-1.18, p = 0.004. Rate of mortality at 90 day was not different between groups: RR 1.17 95% CI 0.93-1.48, p = 0.17. However, the rate of sICH was higher among IVT group: RR 2.93 95% CI 1.53-5.6, p = 0.001. Subgroup analysis showed higher mRS 0-1 among patients who were selected based on perfusion imaging (p < 0.05).

interpretationThe use of IVT in AIS in ETW is beneficial especially with the use of perfusion imaging for patients' selection.

Indexed as

Fibrinolytic AgentsIschemic StrokeThrombolytic TherapyAdministration, IntravenousHumansTime-to-TreatmentFibrinolytic Agents

Identifiers

PMID39469780
PMCPMC11651193

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.