Abstract:
BACKGROUND AND PURPOSE:Pending the results of randomized controlled trials, the benefit and safety of bridging therapy (combined intravenous and intra-arterial thrombolysis) remain to be determined. The aim of this analysis was to give reliable estimates of efficacy and safety outcomes of bridging therapy. METHODS:We conducted a systematic review of all studies using bridging therapy published between January 1966 and March 2011. RESULTS:The literature search identified 15 studies. The pooled estimate for recanalization rate was 69.6% (95% CI, 63.9%-75.0%). Meta-analysis on clinical outcomes showed a pooled estimate of 48.9% (95% CI, 42.9%-54.9%) for favorable outcome, 17.9% (95% CI, 12.7%-23.7%) for mortality, and 8.6% (95% CI, 6.8%-10.6%) for symptomatic intracranial hemorrhage. In meta-regression analysis, the shorter mean time to intravenous treatment, the greater the recanalization rate (per 10-minute decrease: OR, 1.24; 95% CI, 1.02-1.51) and the lower mortality rate (per 10-minute decrease: OR, 0.75; 95% CI, 0.60-0.94). By using the control groups of intravenous alteplase-treated patients in 8 studies, bridging therapy was associated with a favorable outcome (OR, 2.26; 95% CI, 1.16-4.40), but no differences in mortality or symptomatic intracranial hemorrhage outcomes were found. CONCLUSIONS:Bridging therapy is associated with acceptable safety and efficacy in stroke patients. Time to intravenous treatment is critical to improve recanalization rates and favorable outcomes.
journal_name
Strokejournal_title
Strokeauthors
Mazighi M,Meseguer E,Labreuche J,Amarenco Pdoi
10.1161/STROKEAHA.111.635029subject
Has Abstractpub_date
2012-05-01 00:00:00pages
1302-8issue
5eissn
0039-2499issn
1524-4628pii
43/5/1302journal_volume
43pub_type
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