Alteplase for stroke with unknown onset time in chronic kidney disease : a pooled analysis of individual participant data / Kaori Miwa, Masatoshi Koga, Märit Jensen, Manabu Inoue, Sohei Yoshimura, Mayumi Fukuda-Doi, Florent Boutitie, Henry Ma, Peter A. Ringleb, Ona Wu, Lee H. Schwamm, Steven Warach, Werner Hacke, Stephen M. Davis, Geoffrey A. Donnan, Christian Gerloff, Götz Thomalla and Kazunori Toyoda on behalf of Evaluation of Unknown Onset Stroke Thrombolysis Trials (EOS) Investigators

BACKGROUND: Although chronic kidney disease (CKD) is associated with worse stroke outcomes, data regarding the influence of CKD on intravenous thrombolysis outcomes are scarce. We sought to assess the efficacy and safety of intravenous thrombolysis for acute ischemic stroke with unknown onset time in patients with CKD. - METHODS: Patients with an acute stroke of unknown onset time from the EOS trials (Evaluation of Unknown Onset Stroke Thrombolysis) collaboration were evaluated using an individual patient-level database of randomized controlled trials comparing intravenous thrombolysis with placebo/standard treatment. CKD was defined as baseline estimated glomerular filtration rate of <60 ml/min/1.73m2 Mixed-effect logistic-regression analysis was performed to evaluate treatment effects. A favorable outcome was defined as a modified Rankin Scale score of 0 to 1 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage at 22 to 36 hours and 90-day mortality. - RESULTS: Baseline data on renal function were available for 688 of 843 patients. Of these, CKD was present in 146 (21%), including 69 of 351 patients receiving alteplase and 77 of 337 patients receiving placebo/standard treatment. Overall, treatment with alteplase was associated with higher odds of favorable outcome, and CKD did not modify the treatment effect (Pinteraction=0.834). A favorable outcome was observed in 31 of 69 (46%) patients with CKD in the alteplase group and in 28 of 77 (36%) patients with CKD in the control group (adjusted odds ratio, 1.19 [95% CI, 0.55-2.58]). Among patients with CKD, symptomatic intracranial hemorrhage occurred in 2 patients (3%) in the alteplase group but in none of the controls (P=0.133). At 90 days, death was reported in 3 patients (4%) in the alteplase group compared with 2 patients (3%) in the controls (P=0.539). - CONCLUSIONS: The present analysis indicates that the benefit of alteplase does not differ between stroke patients with unknown onset time with and without CKD, although the statistical power was lacking to confirm the efficacy in subgroups. This study only applies to mild-to-moderate or predialysis CKD..

Medienart:

E-Artikel

Erscheinungsjahr:

23 Aug 2022

2022

Erschienen:

23 Aug 2022

Enthalten in:

Zur Gesamtaufnahme - volume:53

Enthalten in:

Stroke - 53(2022), 11, Seite 3295-3303

Sprache:

Englisch

Beteiligte Personen:

Miwa, Kaori [VerfasserIn]
Koga, Masatoshi [VerfasserIn]
Jensen, Märit [VerfasserIn]
Inoue, Manabu [VerfasserIn]
Yoshimura, Sohei [VerfasserIn]
Fukuda-Doi, Mayumi [VerfasserIn]
Boutitie, Florent [VerfasserIn]
Ma, Henry [VerfasserIn]
Ringleb, Peter A. [VerfasserIn]
Wu, Ona [VerfasserIn]
Schwamm, Lee H. [VerfasserIn]
Warach, Steven [VerfasserIn]
Hacke, Werner, 1948- [VerfasserIn]
Davis, Stephen M. [VerfasserIn]
Donnan, Geoffrey A. [VerfasserIn]
Gerloff, Christian, 1963- [VerfasserIn]
Thomalla, Götz, 1973- [VerfasserIn]
Toyoda, Kazunori [VerfasserIn]

Links:

Volltext [lizenzpflichtig]
Volltext [lizenzpflichtig]

Themen:

Brain Ischemia
Cerebral hemorrhage
Fibrinolytic Agents
Glomerular filtration rate
Humans
Intracranial Hemorrhages
Ischemic Stroke
Ischemic stroke
Renal Insufficiency, Chronic
Renal insufficiency
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue-type plasminogen activator
Treatment Outcome

Anmerkungen:

Gesehen am 14.11.2022

Umfang:

9

doi:

10.1161/STROKEAHA.122.039086

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

1822267331

Zugang & Verfügbarkeit




Zugehörige Publikationen/Bände

    Haven't found what you're looking for?