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Meta-Analysis
. 2015 Dec;94(52):e2412.
doi: 10.1097/MD.0000000000002412.

Low-Dose Versus Standard-Dose Tissue Plasminogen Activator in Acute Ischemic Stroke in Asian Populations: A Meta-Analysis

Meng-Dong Liu  1 , Wei-Dong Ning, Ren-Cong Wang, Wei Chen, Yang Yang, Yan Lin, Da-Hai Hu, Wayne-Bond Lau, Yan Qu
Affiliations
Meta-Analysis

Low-Dose Versus Standard-Dose Tissue Plasminogen Activator in Acute Ischemic Stroke in Asian Populations: A Meta-Analysis

Meng-Dong Liu et al. Medicine (Baltimore). 2015 Dec.

Abstract

Recent studies have investigated the most efficacious dose of intravenous tissue plasminogen activator (IV-tPA) for acute ischemic stroke (AIS) patients. There remains no definitive consensus concerning the superior efficacious IV-tPA dose (standard- vs. low-dose), prompting us to perform a meta-analysis comparing the efficacy and safety profile of standard- versus low-dose IV-tPA.We identified relevant studies pertaining to the specific aim of our meta-analysis by searching PubMed and EMBASE (January 1990-September 2015) Either a fixed- or random-effects model was employed (dependent upon data heterogeneity) to analyze the efficacy and safety outcome.Ten cohort studies involving 4389 sum patients were included in the meta-analysis. By using the random-effects model, the meta-analysis indicated no statistically significant difference in favorable functional outcome (modified Rankin scale 0-1) at 3 months (heterogeneity: χ = 17.45, P = 0.04, I = 48%; OR: 0.88 [95% CI: 0.71-1.11]; P = 0.28) and incidence of symptomatic intracranial hemorrhage (SICH) (heterogeneity: χ = 14.41, P = 0.11, I = 38%; OR: 1.19 [95% CI: 0.76 to 1.87]; P = 0.45) between the standard- and low-dose groups. The fixed-effects model demonstrated no significant difference in mortality within 3 months (heterogeneity: χ = 6.73, P = 0.57, I = 0%; OR: 0.91 [95% CI: 0.73-1.12]; P = 0.37) between the standard- and low-dose groups.Low-dose IV-tPA is comparable to standard-dose IV-tPA in both efficacy (favorable functional outcome) and safety (SICH and mortality). Confirmation of these findings through randomized trials is warranted.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Study selection workflow schematic.
FIGURE 2
FIGURE 2
Relationship between IV-tPA dose and favorable functional outcome (0–1) at 3 months.
FIGURE 3
FIGURE 3
Relationship between IV-tPA dose and symptomatic intracranial hemorrhage.
FIGURE 4
FIGURE 4
Relationship between IV-tPA dose and mortality within 3 months.
FIGURE 5
FIGURE 5
Funnel plot assessing publication bias. (A) Funnel plot of favorable functional outcome at 3 months. (B) Funnel plot of symptomatic intracranial hemorrhage. (C) Funnel plot of mortality within 3 months.
See this image and copyright information in PMC

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