title: A comparison of rt-PA thrombolysis guidelines between China and the USA: are changes needed?
abstract: OBJECTIVE
  Thrombolytic treatment criteria vary significantly between China and the USA. We reviewed current intravenous (IV) thrombolytic therapy practices in China and the USA to determine the most appropriate.
  
  
  METHODS
  We conducted a systematic review of studies that used IV recombinant tissue plasminogen activator (rt-PA) therapy in China and the USA published between January 1950 and April 2012.
  
  
  RESULTS
  Literature search identified 17 American and 9 Chinese studies with a total of 2545 subjects. We found a significantly lower mortality rate in the US data compared with China (8% versus 13%; Chi-square  =  24.412, P < 0.001). Our meta-regression analysis uncovered significant factors influencing mortality including male sex, hypertension, high cholesterol, smoking, and onset to treatment time (all P < 0.05). There were significantly more favorable outcomes in China than in the USA (61% versus 49%, Chi-square  =  19.159, P < 0.001). No prior history of stroke and shorter onset to IV time were also significantly associated with a favorable outcome (P < 0.05).
  
  
  CONCLUSIONS
  Onset to IV time is critical for reducing mortality and improving favorable outcomes. We suggest Chinese acute ischemic stroke treatment guidelines be revised to include an increase in the age limit of 80 years, removing contraindications such as a history of previous sever heart, liver, and kidney dysfunction, and placing more emphasis on physician expertise.
authors: Jing
authors: J
authors: Xu
authors: Yongjin
authors: Y
authors: Zhang
authors: Hongyu
authors: H
authors: Wei
authors: Yan
authors: Y
authors: Xu
authors: Min
authors: M
authors: Wang
authors: Zenglin
authors: Z
authors: Cai
authors: Xiaomin
authors: X
authors: Li
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy / Q000453:epidemiology; D002681:China; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke (AIS),; Intravenous thrombolysis,; Meta-analysis; Recombinant tissue plasminogen activator (rt-PA,; alteplase),