Real-World Outcomes of Acute Ischemic Stroke Treatment with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

Background: Evidence from outside the typical clinical research setting, such as the real-world setting, complements evidence coming from randomized controlled trials. The purpose of this study was to evaluate all available evidence from the real-world observational trials about long-term outcomes of treatment with intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) compared with not treated with IV rt-PA (non-rt-PA) in patients with acute ischemic stroke.

Methods: We searched PubMed and Embase until March 1, 2018 for observational studies reporting matched or adjusted results comparing IV rt-PA versus non-rt-PA in patients with acute ischemic stroke. Outcomes assessed included all-cause mortality, hospital readmission rates, and independence rates. Hazard ratios with 95% confidence intervals were used as a measure of comparing between patients treated with IV rt-PA and non-rt-PA.

Results: Six observational trials with 16,399 participants were identified. The use of IV rt-PA in acute ischemic stroke patients was associated with a lower risk of mortality (hazard ratio .61; 95% confidence interval, .52-.70; P < .00001), and there was no heterogeneity across trials. There was no evidence of an effect on hospital readmission rates and independence rates.

Conclusions: IV rt-PA is associated with reduced long-term mortality in acute ischemic stroke patients.