Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review
Abstract Background Repeated intravenous thrombolysis (RIVT) within 3 months is an off-guideline therapy, however, may be an effective and safe way to treat early recurrent ischemic stroke. This study was conducted to assess the potential influencing factors on the efficacy and safety of RIVT in rec...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | BMC Neurology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12883-023-03472-4 |
| _version_ | 1797414807395106816 |
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| author | Si-Yuan Wen Fei-Fei Chen Xiang-Ting Chen Qian Zhang Chang-Qing Zhou |
| author_facet | Si-Yuan Wen Fei-Fei Chen Xiang-Ting Chen Qian Zhang Chang-Qing Zhou |
| author_sort | Si-Yuan Wen |
| collection | DOAJ |
| description | Abstract Background Repeated intravenous thrombolysis (RIVT) within 3 months is an off-guideline therapy, however, may be an effective and safe way to treat early recurrent ischemic stroke. This study was conducted to assess the potential influencing factors on the efficacy and safety of RIVT in recurrent ischemic stroke within 3 months and to explore the strategy of RIVT within 3 months. Methods PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang Database were searched for cases of RIVT in recurrent ischemic stroke within 3 months up to February 1, 2023. Clinical characteristics were compared and analyzed between the good-outcome and poor-outcome groups and between the symptomatic intracranial hemorrhage (sICH) and non-sICH groups respectively. Results A total of 16 studies including 24 cases of RIVT within 3 months were retrospectively analyzed in the present study. The patients’ ages ranged from 42 to 87 years (median 73.5 years) and the intervals between thrombolysis were from 0.25 to 90 days (median 9.5 days). Comparing the clinical characteristics between the good-outcome group and the poor-outcome group, no statistically significant differences were found (P > 0.05), but the differences in baseline National Institutes of Health stroke scale (NIHSS) score of the recurrent stroke (P = 0.056) and good outcome after the previous IVT (P = 0.054) nearly reached statistical significance. Comparing the data between the non-sICH group and the sICH group, statistically significant differences were found in terms of the proportion of cardiogenic embolism (P = 0.036), baseline NIHSS score in the recurrent stroke (P = 0.007) and the interval between thrombolysis (P = 0.041), but no significant difference was found by regression analysis. Conclusion In patients with recurrent ischemic stroke within 3 months, those with a good outcome after the previous IVT and a low baseline NIHSS score in the recurrent stroke may be considered for RIVT, whereas those with a high baseline NIHSS score, a short interval between thrombolysis, and cardiogenic embolism may suffer a higher risk of sICH. Due to sample size and publication bias, more studies with larger sample sizes and more rigorous designs are needed to confirm this conclusion. |
| first_indexed | 2024-03-09T05:39:09Z |
| format | Article |
| id | doaj.art-99082c41c3264465a82ffc9fea791185 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-03-09T05:39:09Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-99082c41c3264465a82ffc9fea7911852023-12-03T12:26:51ZengBMCBMC Neurology1471-23772023-11-012311910.1186/s12883-023-03472-4Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic reviewSi-Yuan Wen0Fei-Fei Chen1Xiang-Ting Chen2Qian Zhang3Chang-Qing Zhou4Department of Neurology, Bishan Hospital of Chongqing Medical UniversityDepartment of Neurology, Bishan Hospital of Chongqing Medical UniversityDepartment of Neurology, Bishan Hospital of Chongqing Medical UniversityDepartment of Neurology, Bishan Hospital of Chongqing Medical UniversityDepartment of Neurology, Bishan Hospital of Chongqing Medical UniversityAbstract Background Repeated intravenous thrombolysis (RIVT) within 3 months is an off-guideline therapy, however, may be an effective and safe way to treat early recurrent ischemic stroke. This study was conducted to assess the potential influencing factors on the efficacy and safety of RIVT in recurrent ischemic stroke within 3 months and to explore the strategy of RIVT within 3 months. Methods PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang Database were searched for cases of RIVT in recurrent ischemic stroke within 3 months up to February 1, 2023. Clinical characteristics were compared and analyzed between the good-outcome and poor-outcome groups and between the symptomatic intracranial hemorrhage (sICH) and non-sICH groups respectively. Results A total of 16 studies including 24 cases of RIVT within 3 months were retrospectively analyzed in the present study. The patients’ ages ranged from 42 to 87 years (median 73.5 years) and the intervals between thrombolysis were from 0.25 to 90 days (median 9.5 days). Comparing the clinical characteristics between the good-outcome group and the poor-outcome group, no statistically significant differences were found (P > 0.05), but the differences in baseline National Institutes of Health stroke scale (NIHSS) score of the recurrent stroke (P = 0.056) and good outcome after the previous IVT (P = 0.054) nearly reached statistical significance. Comparing the data between the non-sICH group and the sICH group, statistically significant differences were found in terms of the proportion of cardiogenic embolism (P = 0.036), baseline NIHSS score in the recurrent stroke (P = 0.007) and the interval between thrombolysis (P = 0.041), but no significant difference was found by regression analysis. Conclusion In patients with recurrent ischemic stroke within 3 months, those with a good outcome after the previous IVT and a low baseline NIHSS score in the recurrent stroke may be considered for RIVT, whereas those with a high baseline NIHSS score, a short interval between thrombolysis, and cardiogenic embolism may suffer a higher risk of sICH. Due to sample size and publication bias, more studies with larger sample sizes and more rigorous designs are needed to confirm this conclusion.https://doi.org/10.1186/s12883-023-03472-4Recurrent ischemic StrokeRepeated intravenous thrombolysisWithin 3 monthsSymptomatic intracranial Hemorrhage |
| spellingShingle | Si-Yuan Wen Fei-Fei Chen Xiang-Ting Chen Qian Zhang Chang-Qing Zhou Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review BMC Neurology Recurrent ischemic Stroke Repeated intravenous thrombolysis Within 3 months Symptomatic intracranial Hemorrhage |
| title | Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review |
| title_full | Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review |
| title_fullStr | Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review |
| title_full_unstemmed | Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review |
| title_short | Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review |
| title_sort | repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months a systematic review |
| topic | Recurrent ischemic Stroke Repeated intravenous thrombolysis Within 3 months Symptomatic intracranial Hemorrhage |
| url | https://doi.org/10.1186/s12883-023-03472-4 |
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