title: Low-Dose Versus Standard-Dose Tissue Plasminogen Activator in Acute Ischemic Stroke in Asian Populations: A Meta-Analysis.
abstract: Recent studies have investigated the most efficacious dose of intravenous tissue plasminogen activator (IV-tPA) for acute ischemic stroke (AIS) patients. There remains no definitive consensus concerning the superior efficacious IV-tPA dose (standard- vs. low-dose), prompting us to perform a meta-analysis comparing the efficacy and safety profile of standard- versus low-dose IV-tPA.We identified relevant studies pertaining to the specific aim of our meta-analysis by searching PubMed and EMBASE (January 1990-September 2015) Either a fixed- or random-effects model was employed (dependent upon data heterogeneity) to analyze the efficacy and safety outcome.Ten cohort studies involving 4389 sum patients were included in the meta-analysis. By using the random-effects model, the meta-analysis indicated no statistically significant difference in favorable functional outcome (modified Rankin scale 0-1) at 3 months (heterogeneity: χ = 17.45, P = 0.04, I = 48%; OR: 0.88 [95% CI: 0.71-1.11]; P = 0.28) and incidence of symptomatic intracranial hemorrhage (SICH) (heterogeneity: χ = 14.41, P = 0.11, I = 38%; OR: 1.19 [95% CI: 0.76 to 1.87]; P = 0.45) between the standard- and low-dose groups. The fixed-effects model demonstrated no significant difference in mortality within 3 months (heterogeneity: χ = 6.73, P = 0.57, I = 0%; OR: 0.91 [95% CI: 0.73-1.12]; P = 0.37) between the standard- and low-dose groups.Low-dose IV-tPA is comparable to standard-dose IV-tPA in both efficacy (favorable functional outcome) and safety (SICH and mortality). Confirmation of these findings through randomized trials is warranted.
authors.affiliation: From the Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, P.R. China (M-DL, D-HH); Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, P.R. China (WC, R-CW, YY); Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, P.R. China (W-DN, YQ); Department of Scientific Research, Fourth Military Medical University, Xi'an, P.R. China (YL); and Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA (W-BL).
authors.forename: Meng-Dong
authors.initials: MD
authors.lastname: Liu
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Ning
authors.forename: Ren-Cong
authors.initials: RC
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.forename: Yan
authors.initials: Y
authors.lastname: Lin
authors.forename: Da-Hai
authors.initials: DH
authors.lastname: Hu
authors.forename: Wayne-Bond
authors.initials: WB
authors.lastname: Lau
authors.forename: Yan
authors.initials: Y
authors.lastname: Qu
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator