Ver el código de «EBQ:Studies List of Thrombolytics for Acute Stroke»

'''MAST-Italy''' (n = 622) <ref>Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Multicentre Acute Stroke Trial--Italy (MAST-I) Group. 1995;346(8989):1509–1514</ref>
* Time to treatment: < 6 hours
* Results: Increased early death (OR 2.7), Slight decrease 6 m disability (OR 0.5)
* Overall: No benefit

'''ECASS''' (n = 620) <ref>Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). 1995;274(13):1017–1025</ref>
* Time to treatment: < 6 hours, Notable inclusion: Moderate - severe hemispheric stroke
* Results: No difference in disability or death
* Overall: No benefit

'''NINDS-1''' (n = 291) <ref>Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–1587. doi:10.1056/NEJM199512143332401.</ref>
* Time to treatment: < 3 hours
* Results: No difference NIHSS improvement by 4 pts or resolution of deficits at 24 hours
* Overall: No benefit

'''NINDS-2''' (n = 333) <ref>Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–1587. doi:10.1056/NEJM199512143332401</ref>
* Time to treatment: < 3 hours
* Results: Initial primary outcome was to be improvement in functional and stroke scores (of 20%). This was changed, post-hoc, to dichotomous favorable vs. unfavorable outcome. Original primary outcome result not reported.
* Overall: Benefit = NNT of 8 for 'favorable’ outcome measure

'''MAST-Europe''' (n = 310) <ref> Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Multicentre Acute Stroke T
Trial--Italy (MAST-I) Group. The Lancet. 1995;346(8989):1509–1514.</ref>
* Time to treatment: < 6 hours
* Notable Inclusion: Mod-severe stroke, MCA territory only
* Outcome: No difference combined disability/death at 6 months; increased ICH (21% vs. 3%) and statistically nonsignificant increased mortality (47% vs. 38%)
* Overall: Harmful (STOPPED EARLY DUE TO ICH AND MORTALITY)

'''ASK''' (n = 340) <ref>Streptokinase for acute ischemic stroke with relationship to time of administration: Australian Streptokinase (ASK) Trial Study Group. 1996;276(12):961–966.</ref>
* Time to treatment: <4h (small % 4-5h)
* Outcome: No difference combined disability/death at 3 months; slightly decreased disability and increased mortality at 3 months, OR 1.83 (1.14-2.93)
* Overall: Harmful (STOPPED EARLY DUE TO MORTALITY)

'''ECASS-II with tPA''' (n = 800) <ref>Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. 1998;352(9136):1245–1251</ref>
* Time to treatment: <6h (20% < 3 hours)
* Outcome: No difference in favorable outcomes (modified Rankin Scale) at 3 months
* Overall: No benefit

'''ATLANTIS-B with tPA''' (n = 613) <ref>Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. 1999;282(21):2019–2026</ref>
* Time to treatment: 20% 3-4 h, 70% 4-5
* Outcome: No difference, favorable outcome at 3 months; increased ICH (7% vs. 1%) and nonsignificant increase in mortality (11% vs. 7%)
* Overall: Harmful (STOPPED EARLY BECAUSE “unlikely to prove beneficial)

'''ATLANTIS-A with tPA''' (n = 142) <ref>ATLANTIS trial: results for patients treated within 3 hours of stroke onset. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. 2002;33(2):493–495</ref> <ref>Clark WM, Albers GW, Madden KP, Hamilton S. The rtPA (Alteplase) 0- to 6-Hour Acute Stroke Trial, Part A (A0276g) : Results of a Double-Blind, Placebo-Controlled, Multicenter Study. Stroke. 2000;31(4):811–816. doi:10.1161/01.STR.31.4.811</ref>
* Time to treatment: Initially 0-6 hours, stopped enrolling 0-3hrs and only enrolled 0-5hrs based on NINDS result
* Outcome: Improvement in NIHSS score (4 pts) at 24h favored lytics (40% vs. 21%, p=0.02) but at 1 month favored placebo (75% vs. 60%, p=0.05). Increased ICH with tPA (11% vs. 0%) and increased mortality at 3 months (23% vs. 7%)
* Overall: Harmful (STOPPED EARLY DUE TO HARM)

'''DIAS-2 with desmoteplase''' (n = 193) <ref>Hacke W, Furlan AJ, Al-Rawi Y, et al. Intravenous desmoteplase in patients with acute ischaemic stroke selected by MRI perfusion–diffusion weighted imaging or perfusion CT (DIAS-2): a prospective, randomised, double-blind, placebo-controlled study. Lancet Neurol. 2009;8(2):141–150. doi:10.1016/S1474-4422(08)70267-9</ref>
* Time to treatment: 3-9 hours Notable inclusion: reversible ischemic penumbra on MR or CT
* Outcome: No difference in favorable outcomes; Nonsignificant increase in mortality for high dose desmoteplase group (stopped early for harm then restarted)
* Overall: No benefit

'''[[ECASS III]] with tPA''' (n = 821) <ref>Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. The New England Journal of Medicine. 2008;359(13):1317–1329. doi:10.1056/NEJMoa0804656.</ref>
* Time to treatment: 3-4.5 h
* Outcome: More favorable outcomes with tPA (OR 1.34, 1.02-1.76), mortality no difference
* Overall: Benefit = NNT of 15 for ‘favorable’ outcomes

'''IST-3 with tPA''' (n = 3035)<ref>Sandercock PP, Wardlaw JMJ, Lindley RIR, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. The Lancet. 2012;379(9834):2352–2363. doi:10.1016/S0140-6736(12)60768-5.</ref>
* Time to treatment: 0-6 h
* Outcome: Short term mortality increase of 4% (1st week); no difference found in primary outcome (% alive and independent at 6 months); authors report a secondary analysis favoring thrombolytics
* Overall: No benefit

==See Also==
*[[Thrombolysis in Acute Ischemic Stroke (tPA)]]

==External Links==
* http://smartem.org/podcasts/smart-thrombolytics-acute-stroke

==References==
<references/>

[[Category:EBQ]]
[[Category:Neurology]]