Comparison of partial (.6 mg/kg) versus full-dose (.9 mg/kg) intravenous recombinant tissue plasminogen activator followed by endovascular treatment for acute XXXX : a meta-analysis.

@entity1 @entity1779 @entity385
BACKGROUND: In the treatment of acute @entity385 , intravenous (IV) recombinant tissue plasminogen (rt-PA) and intraarterial (IA) interventions are often combined. However, the optimal dose of IV rt-PA preceding endovascular treatment has not been established. METHODS: Studies that used combined IV and IA thrombolysis were identified from a search of the MEDLINE, PubMed, and Cochrane databases. We compared the rates of angiographic recanalization, symptomatic @entity1779 (sICH), and favorable functional outcome between @entity1 who had been treated with .6 mg/kg IV rt-PA and those who had received .9 mg/kg rt-PA. RESULTS: Eleven studies met our criteria. In 7 studies, .6 mg/kg IV rt-PA had been administered to 317 @entity1 , whereas 140 @entity1 in 4 studies had received .9 mg/kg of IV rt-PA. The weighted mean of median National Institutes of Health Stroke Scale score at presentation was 18.3 in the .6 mg/kg group (median range 9-34), and 17.3 in the .9 mg/kg group (median range 4-39). @entity1 in the .9 mg/kg group had higher rates of favorable outcome [odds ratio (OR)=1.60, 95% confidence interval (CI)=(1.07-2.40), P=.022] and similar rates of sICH [OR=.86 (95% CI .41-1.83), P=.70]. Depending on the statistics used, the higher angiographic recanalization rate among @entity1 treated with .9 mg/kg was significant (P=.03, events/trial syntax logistic regression) or borderline significant (P=.07, random effects model). CONCLUSION: Our analysis suggests that using .9 mg/kg IV rt-PA prior to IA thrombolysis is safe and may be associated with higher recanalization rates and better functional outcome at 3 months.
