Research Article
Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis
Table 1
The baseline characteristics of the included studies in the meta-analysis (study quality of non-RCTs was shown).
| | Study | Barreto 2009 [15] | Breuer 2010 [28] | Michel 2011 | Kang 2012 [16] | Manawadu 2013 [27] | Bal 2014 [25] | Anaissie 2016 [26] | Thomalla 2018 [12] |
| | Region | USA | Germany | USA | Korea | UK | Canada | USA | Germany | | Design | Retrospective | Prospective | RCT | Prospective | Prospective | Retrospective | Retrospective | RCT | | Period | 2003.03-2008.01 | 2006.10-2008.05 | 2004.06-2007.12 | 2006.09-2009.07 | 2009.01-2010.12 | 2003.01-2010.03 | 2008.07-2014.05 | 2012.09-2017.06 | | Outcome assessment time | NA | 90 days | 90 days | 90 days | 90 days | 90 days | 90 days | 90 days | | Admission time (h) | 3 | 6 | 3 | 3 | 4.5 | NA | 4.5 h | 4.5 h | | Preexamination | All NCT, 10 CT perfusion, 6 MRI | All NCT, 43 MRI, 2 CTA | All NCT+CT perfusion | All NCT+MRI | All NCT, 64 CTP | All NCT, CTA | All NCT | All NCT+MRI | | No. of patients | | | | | | | | | | Thrombolysis | 46 | 10 | 6 | 83 | 68 | 29 | 46 | 254 | | Conservative | 34 | 35 | 6 | 156 | 54 | 41 | 154 | 249 | | Age (y) | | | | | | | | | | Thrombolysis | a | 73 (57-92)b | 69.5 (57-78)b | NA | a | 68 (23)c | 69 (42-98)b | a | | Conservative | a | 66 (39-87)b | 49 (44-78)b | NA | a | 74 (21)c | 63 (22-93)b | a | | Gender | | | | | | | | | | Thrombolysis | 39 | 5 | 3 | 55 | 23 | 12 | 22 | 165 | | Conservative | 44 | 23 | 3 | 88 | 28 | 17 | 85 | 160 | | NIHSS | | | | | | | | | | Thrombolysis | 16 (3-24)b | 10.5 (1-22)b | 17 (13-21)b | 14 (10-18)c | 11.5 (8-17)c | 14 (11)c | 9.5 (1-27)b | 6 (4–9)c | | Conservative | 10.5 (2-26)b | 6 (1-21)b | 14.5 (12-19)b | 12 (6.25-17)c | 9 (5-15)c | 13 (11)c | 5 (0-33)b | 6 (4–9)c | | HT | | | | | | | | | | Thrombolysis | 30 | 9 | 4 | 54 | 45 | 18 | 36 | 135 | | Conservative | 22 | 29 | 1 | 94 | 32 | 27 | 119 | 131 | | DM | | | | | | | | | | Thrombolysis | 10 | 4 | 1 | 23 | 14 | 3 | 20 | 43 | | Conservative | 11 | 13 | 0 | 57 | 13 | 7 | 45 | 39 | | CAD | | | | | | | | | | Thrombolysis | 8 | 3 | 0 | NA | NA | NA | NA | NA | | Conservative | 5 | 6 | 0 | NA | NA | NA | NA | NA | | Smoking | | | | | | | | | | Thrombolysis | NA | 1 | 0 | 30 | 8 | 13 | NA | NA | | Conservative | NA | 9 | 2 | 54 | 7 | 19 | NA | NA | | AF | | | | | | | | | | Thrombolysis | NA | NA | 2 | NA | 21 | 10 | 6 | 30 | | Conservative | NA | NA | 0 | NA | 9 | 18 | 21 | 29 | | Previous stroke | | | | | | | | | Thrombolysis | NA | 5 | NA | 19 | NA | NA | NA | 37 | | Conservative | NA | 9 | NA | 31 | NA | NA | NA | 31 | | Hyperlipidemia | | | | | | | | | | Thrombolysis | 12 | 8 | 4 | 24 | 22 | 9 | 19 | 93 | | Conservative | 9 | 27 | 3 | 40 | 25 | 6 | 60 | 85 | | TOAST classification | | | | | | | | | | Cardioembolic | | | | | | | | | | Thrombolysis | 20 | 4 | 2 | 31 | 33 | NA | 11 | NA | | Conservative | 14 | 8 | 0 | 57 | 21 | NA | 34 | NA | | Large artery atherosclerosis | | | | | | | | Thrombolysis | 15 | 2 | 2 | 46 | 14 | NA | 8 | NA | | Conservative | 7 | 10 | 0 | 77 | 11 | NA | 27 | NA | | Small vessel | | | | | | | | | | Thrombolysis | 1 | 1 | 0 | 0 | 4 | NA | 3 | NA | | Conservative | 5 | 7 | 4 | 0 | 12 | NA | 53 | NA | | Unknown | | | | | | | | | | Thrombolysis | 5 | 2 | 2 | NA | 13 | NA | 17 | NA | | Conservative | 5 | 8 | 2 | NA | 13 | NA | 25 | NA | | Other | | | | | | | | | | Thrombolysis | 5 | 1 | 0 | 6 | 4 | NA | 7 | NA | | Conservative | 2 | 2 | 0 | 22 | 2 | NA | 14 | NA | | LSN to symptom onset | | | | | | | | | Thrombolysis | NA | NA | NA | NA | NA | NA | NA | 7.2 (4.7–8.7) hc | | Conservative | NA | NA | NA | NA | NA | NA | NA | 7.0 (5.0–9.0) hc | | LSN to door | | | | | | | | | | Thrombolysis | NA | 508 (200-691) minb | NA | 8.6 (5.4-11.1) hc | NA | NA | NA | NA | | Conservative | NA | 577 (182-849) minb | NA | 7.8 (4.9-11.7) hc | NA | NA | NA | NA | | LSN to thrombolysis | | | | | | | | | | Thrombolysis | a | NA | 564 (390–805) minb | NA | NA | NA | NA | 10.3 (8.1–12.0) hc | | Conservative | NA | NA | 437.5 (330–656) minb | NA | NA | NA | NA | 10.4 (8.1–12.1) hc | | Symptom onset to door | | | | | | | | | Thrombolysis | a | 93 (20-287) minb | NA | 1.7 (0.9-2.7) hc | NA | a | NA | 2.6 (1.9–3.3) hc | | Conservative | a | 95 (38-360) minb | NA | 2.0 (1.0-3.6) hc | NA | a | NA | 2.6 (2.1–3.3) hc | | Symptom onset to thrombolysis | | | | | | | | Thrombolysis | a | NA | NA | 4.6 (2.8-6.0) hc | NA | a | NA | 3.1 (2.5–3.8) hc | | Conservative | NA | NA | NA | NA | NA | NA | NA | 3.2 (2.6–3.9) hc | | Door to treatment | | | | | | | | | | Thrombolysis | a | 80 (45–127) minb | 109.5 (85–131) minb | 155 (100–195) minc | NA | NA | NA | 25 (16–35) minc | | Conservative | NA | NA | 113 (75–205) minb | NA | NA | NA | NA | 26 (18–37) minc | | Good outcome | | | | | | | | | | Thrombolysis | 13 | 5 | 4 | 37 | 25 | 14 | 22 | 188 | | Conservative | 4 | 21 | 1 | 51 | 14 | 17 | 66 | 162 | | Mortality | | | | | | | | | | Thrombolysis | 7 | 2 | 0 | NA | 10 | 7 | 2 | 10 | | Conservative | 0 | 0 | 0 | NA | 14 | 3 | 6 | 3 | | NIHSS at 24 h | | | | | | | | | | Thrombolysis | NA | 7.5 (0-18)b | 10.5 (7-19)b | NA | 6 (2, 13.5)c | 10 (13)c | 4 (0-24)b | NA | | Conservative | NA | 5 (0-21)b | 19.5 (6-24)b | NA | 5 (3, 10)c | 10.5 (15.5)c | 3 (0-29)b | NA | | NIHSS change at 24 h | | | | | | | | | | Thrombolysis | NA | NA | NA | NA | -4 (-8, 0)c | NA | -2 (-16, 19)b | NA | | Conservative | NA | NA | NA | NA | -3 (-4, 0)c | NA | -1 (-13, 17)b | NA | | NIHSS at discharge | | | | | | | | | | Thrombolysis | NA | 6 (0–21)b | NA | NA | NA | NA | 3 (2-42)b | NA | | Conservative | NA | 3 (0–15)b | NA | NA | NA | NA | 3 (0-42)b | NA | | sICH | | | | | | | | | | Thrombolysis | 2 | 0 | 2 | NA | 2 | 2 | 1 | 20 | | Conservative | 0 | 0 | 2 | NA | 0 | 2 | 1 | 12 | | ICH | | | | | | | | | | Thrombolysis | NA | 1 | 2 | NA | 15 | 5 | NA | NA | | Conservative | NA | 0 | 2 | NA | 2 | 1 | NA | NA | | Study quality | 7 | 6 | NA | 8 | 8 | 7 | 6 | NA |
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RCT: randomized controlled trial; CT: computed tomography; NCT: noncontrast CT; MRI: magnetic resonance imaging; a: ; b: median (minimum-maximum); c: mean (interquartile); y: year; h: hour; min: minute; NA: not applicable; HT: hypertension; DM: diabetes mellitus; CAD: cardiovascular disease; AF: arterial fibrillation; mRS: modified Rankin Scale; NIHSS: National Institutes of Health Stroke Scale; LSN: last seen normal; ICH: intracerebral hemorrhage; sICH: symptomatic ICH. |
