机构：[1]Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow University, Suzhou, China[2]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[3]China National Clinical Research Center for Neurological Diseases, Beijing, China[4]Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China[5]Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China[6]Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St. Francis Healthcare System, University of Illinois College of Medicine, Peoria, Illinois.
Background: We performed a meta-analysis to compare the efficacy and safety between low- and standard-dose intravenous (IV) tissue-type plasminogen activator (tPA) for acute ischemic stroke (AIS) patients within 4.5 hours of symptom onset. Methods: We searched PubMed and EMBASE for relevant studies from inception to June1, 2017. Cohort or randomized controlled studies for AIS within 4.5 hours of symptom onset with comparison between low-dose and standard-dose tPA were included. The primary efficacy end point was favorable functional outcome (modified Rankin scale scores [mRS] of 0-1) at 90 days. The primary safety end point was the incidence rate of symptomatic intracerebral hemorrhage (sICH). The secondary end points were independent functional outcome (mRS scores of 0-2) and mortality. Results: A total of 11 studies were pooled in this meta-analysis. The low-dose strategy appeared to be as effective as standard-dose tPA (43.4% versus 45.4%; odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.78-1.10; P=.38) in primary efficacy outcome. The secondary efficacy outcome produced similar results (57.3% versus 57.0%; OR = 0.95, 95% CI: 0.86-1.05; P=.33). There was no evidence of statistical difference for sICH (4.2% versus 4.9%; OR = 1.02 [0.66-1.55]; P=.94) and mortality (9.0% versus 10.6%; OR = 0.99 [0.74-1.31]; P=.92) at 90 days between low-and standard-dose therapy. In a subgroup analysis by ethnicity, there was no significant difference between patients of Asian and non-Asian descent for any of the end points. Conclusions: This study showed that AIS patients receiving low-dose IV-tPA had comparably efficacy and safety to those receiving standard-dose IV-tPA. However, the effect is especially pronounced within the Asian population, which limits the generalizability of these results.
基金：
This study was funded by Jiangsu Provincial Medical Key Discipline Project (ZDXKB 2016022); Suzhou Clinical Research Center of Neurological
Disease (Szzx201503).
第一作者机构：[1]Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow University, Suzhou, China
共同第一作者：
通讯作者：
通讯机构：[*1]Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, Second Affiliated Hospital of Soochow University, Suzhou 215004. China.[*2]Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantanxili, Dongcheng District, Beijing 100050, China.
推荐引用方式(GB/T 7714)：
Huihui Liu,Huaguang Zheng,Yongjun Cao,et al.Low- versus Standard-Dose Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: An Updated Meta-Analysis[J].JOURNAL OF STROKE & CEREBROVASCULAR DISEASES.2018,27(4):988-997.doi:10.1016/j.jstrokecerebrovasdis.2017.11.005.
APA：
Huihui Liu,Huaguang Zheng,Yongjun Cao,Yuesong Pan,David Wang...&Yilong Wang.(2018).Low- versus Standard-Dose Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: An Updated Meta-Analysis.JOURNAL OF STROKE & CEREBROVASCULAR DISEASES,27,(4)
MLA：
Huihui Liu,et al."Low- versus Standard-Dose Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: An Updated Meta-Analysis".JOURNAL OF STROKE & CEREBROVASCULAR DISEASES 27..4(2018):988-997
