Efficacy and Safety of rt-PA Intravenous Thrombolysis in Patients with Wake-up Stroke: A Meta-Analysis

Abstract

\n Background\n\nRecombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies for patients with acute ischemic stroke. However, wake-up stroke (WUS) is typically excluded from intravenous thrombolytic therapy because the time of symptom onset is unclear. Therefore, we aimed to assess the efficacy and safety of rt-PA intravenous thrombolysis in patients with WUS by meta-analysis.\nMethods\n\nWe completed a systematic literature search of PubMed, Embase, the Cochrane Library, and SinoMed and included relevant studies of WUS patients covering rt-PA thrombolysis and nonthrombolysis (published from January 1, 2000, to February 28, 2021, with no language restrictions). Primary outcomes included safety outcomes and functional outcomes. Safety outcomes was measured according to the incidence of symptomatic intracranial hemorrhage (SICH) and mortality within 90 days. Efficacy outcomes was measured based on 90-day modified Rankin Scale (mRS) score. We assessed pooled data using either a random-effects model (when P\u2009<\u20090.10, I2\u2009>\u200950%) or a fixed-effects model (when P\u2009>\u20090.10, I2\u2009<\u200950%).\nResults\n\nNine studies with 913 patients were included in the meta-analysis. All patients had ischemic stroke confirmed by computed tomography or magnetic resonance imaging. The incidence of mRS 0–2 was significantly higher in the rt-PA thrombolysis group compared with the nonthrombolysis group. And rt-PA thrombolytic WUS patients did not differ significantly from nonthrombolytic WUS patients in terms of 90-day mortality. However, the rate of SICH was also significantly higher in the rt-PA thrombolysis group than that in the nonthrombolysis group.\nConclusions\n\nPatients with WUS who received rt-PA thrombolysis had a significant positive effect within 90 days. In addition, although there is no significant increase in mortality, we need to be aware of the risk of intracranial hemorrhage transformation associated with rt-PA thrombolysis despite no obvious increase in mortality. The safety of rt-PA intravenous thrombolysis should be closely monitored in patients with WUS.