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Golden Hour Intravenous Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.
Al-Ajlan, Fahad S; Alkhiri, Ahmed; Alamri, Aser F; Alghamdi, Basil A; Almaghrabi, Ahmed A; Alharbi, Abdullah R; Alansari, Nayef; Almilibari, Ahmed Z; Hussain, M Shazam; Audebert, Heinrich J; Grotta, James C; Shuaib, Ashfaq; Saver, Jeffrey L; Alhazzani, Adel.
Afiliación
  • Al-Ajlan FS; Neuroscience Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
  • Alkhiri A; Alfaisal University, Riyadh, Saudi Arabia.
  • Alamri AF; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  • Alghamdi BA; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Almaghrabi AA; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
  • Alharbi AR; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
  • Alansari N; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  • Almilibari AZ; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Hussain MS; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  • Audebert HJ; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Grotta JC; Department of Neurology, King Abdullah Medical City, Makkah, Saudi Arabia.
  • Shuaib A; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  • Saver JL; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Alhazzani A; College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
Ann Neurol ; 96(3): 582-590, 2024 Sep.
Article en En | MEDLINE | ID: mdl-38922985
ABSTRACT

OBJECTIVES:

The benefits of intravenous thrombolysis are time-dependent, with maximum efficacy when administered within the first "golden" hour after onset. Nevertheless, the impact of golden hour thrombolysis has not been well quantified.

METHODS:

Medline, Embase, and Web of Science databases were systematically searched from inception to August 27, 2023. We included studies that reported safety and efficacy outcomes of ischemic stroke patients treated with intravenous thrombolysis in the golden hour versus later treatment window. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0-1 at 90 days. The secondary efficacy outcome was a good functional outcome (defined as modified Rankin Scale score of 0-2). The main safety outcome was symptomatic intracerebral hemorrhage.

RESULTS:

Seven studies involving 78,826 patients met the selection criteria. Golden hour thrombolysis was associated with higher odds of 90-day excellent functional outcomes (OR 1.40, 95% CI 1.16-1.67) and 90-day good functional outcomes (OR 1.38, 95% CI 1.13-1.69) compared with thrombolysis outside the golden hour. The number needed to treat to benefit for golden hour thrombolysis to reduce disability by at least 1 level on the modified Rankin Scale per patient was 2.6. Rates of symptomatic intracerebral hemorrhage and mortality were similar between groups.

INTERPRETATION:

Golden hour thrombolysis significantly improved acute ischemic stroke outcomes. The findings provide rationale for intensive efforts aimed at expediting thrombolytic therapy within the golden hour window following the onset of acute ischemic stroke. ANN NEUROL 2024;96582-590.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Fibrinolíticos / Tiempo de Tratamiento / Accidente Cerebrovascular Isquémico Límite: Humans Idioma: En Revista: Ann Neurol Año: 2024 Tipo del documento: Article País de afiliación: Arabia Saudita Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Terapia Trombolítica / Fibrinolíticos / Tiempo de Tratamiento / Accidente Cerebrovascular Isquémico Límite: Humans Idioma: En Revista: Ann Neurol Año: 2024 Tipo del documento: Article País de afiliación: Arabia Saudita Pais de publicación: Estados Unidos