Systemic Recombinant Tissue Plasminogen Activator for Treatment of Acute Ischemic Cerebral Stroke: A Systematic Review

Abstract

Background: Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled. Aim of Study: To evaluate the efficacy of using recom-binant tissue plasminogen activator in treatment of acute ischemic cerebral stroke showing its effect on morbidity and mortality. Material and Methods: In this study, we searched Medline via PubMed, SCOPUS, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar from their inception till April 2020. The search retrieved 1806 unique records. We then retained 54 potentially eligible records for full-texts screening. Finally, 13 studies (No. of patients =7322 patients) were included. Results: The overall effect showed that rtPA significantly increased the chance of being alive independent (mRS0-2) [OR=1.21 95% CI (1.05, 1.41); p=0.01]. Also increased the favorable outcomes (mRS 0-1) [OR=1.34 95% CI (1.12-1.60); p=0.001]. The risk of sICH increased [OR=3.93 95% CI (2.44, 6.35); p=0.00001] and the overall mortality showed no differ-ence [OR=1.11 95% CI (0.90, 1.38); p=0.01]. The pooled studies showed no significant heterogeneity. Conclusion: The evidence indicates that intravenous rt-PA increased the proportion of patients who were alive-with favorable outcome and alive and independent at final-follow-up. This benefit occurred despite an increase in the-number of early symptomatic intracranial hemorrhages an-dearly deaths. The overall mortality at the end of follow-up is not significantly increased.