title: Erythropoietin Treatment in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Erythropoietin (EPO) for treating acute ischemic stroke (AIS) has been investigated in many studies. However, the evidence was inconsistent. Thus, a systematic review and metaanalysis were performed to elucidate the role of EPO in treating patients with AIS.
  
  
  METHODS
  Two electronic databases (PubMed and EMBASE) were used. 30-day NIHSS measures primary outcome while all-cause mortality in the follow up and 90-day Barthel Index were regarded as secondary outcome. Results are presented as relative risk (RR), standardized mean difference (SMD) and 95% confidence intervals (CI). We employed Stata software to perform the meta-analysis.
  
  
  RESULTS
  Four randomized controlled trials (RCTs) involving 784 patients were contained in this metaanalysis. The total combined results on 30-day NIHSS were (SMD = -0.52, 95% CI: -1.39, 0.34) with random-effects model and sensitivity analysis showed a significant difference after excluding the Ehrenreich 2009 trial. The total combined secondary measured results were (RR=1.72, 95% CI: 1.10, 2.70) and (SMD = 0.01, 95% CI: -0.14, 0.16) for all-cause mortality and 90-day Barthel Index. In the subgroup analysis by using recombinant tissue plasminogen activator (rtPA) earlier, the rtPA group showed increased all-cause mortality with the result of (RR = 1.92, 95% CI: 1.04, 3.52), but not in non-rtPA group.
  
  
  CONCLUSIONS
  To our systematic review and meta-analysis, we didn't recommend EPO administration for patients with AIS, especially with the combination of rtPA. Large RCTs are warranted to examine EPO efficacy in AIS patients in the future.
authors.affiliation: Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
authors.forename: Xiyang
authors.initials: X
authors.lastname: Yao
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
authors.forename: Dapeng
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
authors.forename: Haiying
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
authors.forename: Haitao
authors.initials: H
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, Taicang First People's Hospital, Taicang, 215400, China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Shu
authors.affiliation: Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
mesh_terms: D000818:Animals; D002545:Brain Ischemia / Q000188:drug therapy*; D004921:Erythropoietin / Q000494:pharmacology* / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; erythropoietin; meta-analysis; randomized controlled trials; recombinant tissue plasminogen
  activator; systematic review