Stroke: different doses of thrombolytics and agents had no clear effect on death.

Clinical bottom line (level 1a-)

  1. Patients with acute ischaemic stroke who were given a high dose of a thrombolytic drug had no clear difference in death or significant intracranial haemorrhage, than those given a low dose.
  2. Patients given urokinase had no clear difference in death, than those given another thrombolytic.
  3. Patients given tissue plasminogen activator had no clear difference in death, than those given urokinase.
  4. Patients given tissue plasminogen activator or tissue-cultured urokinase had no clear difference in significant or fatal intracranial haemorrhage, than those given conventional urokinase.
Liu and Wardlaw: The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
Expires December 2002

The study

Systematic review of unconfounded randomised or quasi-randomised trials. of
  • Patients: within 14 days of acute ischaemic stroke
  • Intervention: thrombolytic drugs of different doses or routes compared with placebo
  • Outcome: death or haemorrhage


    • Articles found in ? language using Cochrane Stroke Group trials register, EMBASE, 1980 to 1997 (search terms: stroke, cerebrovascular disease, thrombol*, urokinase, pro-urokinase, streptokinase, tissue plasminogen activator, lumbrokinase ) and handsearched Japanese and Chinese journals and contacted researchers in the field and pharmaceutical companies.

    Selection criteria: data on different doses, different routes of administration and comparison of different thrombolytics.
    Appraisal criteria: detailed in text
    Articles excluded if: none given

    Eight trials involving 1334 patients were included.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN?
    (% CI)
    death with high vs low doses unknown /
    (%)    		 1.20
    (0.58 to 2.48)
    significant intracranial haemorrhage with high vs low doses unknown /
    (%)    		 1.57
    (0.72 to 3.40)
    death with urokinase vs another drug 2 weeks /
    (%)    		 0.90
    (0.27 to 2.98)
    death with tissue plasminogen activator vs urokinase unknown /
    (%)    		 0.72
    (0.26 to 2.02)
    significant and fatal intracranial haemorrhage with TPA or tissue-cultured urokinase vs normal urokinase unknown /
    (%)    		 0.26
    (0.06 to 1.18)

    Citation

    1. Liu M, and Wardlaw J: Thrombolysis (different doses, routes of administration and agents) for acute ischaemic stroke (Cochrane Review). The Cochrane Library, Issue 2, Oxford: Update Software 1999; 2: -
    Contributor: Clare Wotton and Musab Hayatli, December 1999
    Reviewer:

    Clinical Question.
    Patient acute ischaemic stroke
    Intervention or Exposure thrombolytic drugs
    Comparison placebo
    Outcome death or intracranial haemorrhage