Abstract Details

Title Efficacy and Safety of Fibrinolytics in Patients with Acute Ischaemic Stroke and Transient Ischaemic Attack: A Network Meta-Analysis of Randomized Controlled Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-010

Objective Our Frequentist network meta-analysis (NMA) aims to explore the efficacy and safety outcomes of various fibrinolytic regimens in managing acute ischaemic stroke (AIS) and transient ischaemic attack (TIA) patients.

Background Intravenous thrombolysis with an alteplase bolus followed by infusion is the global standard of care for patients with AIS and TIA. However, emerging fibrinolytics have shown promising potential in terms of efficacy and safety, though it remains unclear which is superior for treating AIS and TIA

Design/Methods A comprehensive search of PubMed, Embase, and Cochrane databases was conducted to identify randomized controlled trials (RCTs) comparing various fibrinolytic regimens in patients with AIS and TIA, assessing the risk of 30-day and 90-day mortality, intracranial hemorrhage (ICH), and early neurological improvement (ENI).

Results

A total of 30 RCTs were included with 15,695 patients. There was a statistically significant ENI in patients who underwent thrombolysis with tenecteplase compared with alteplase (RR 1.20; 95% CI 1.04-1.41) and no thrombolytic therapy (RR 1.33; 95% CI 1.02-1.75). There was no significant difference in risk of ICH, or mortality at 30 days and 90 days across any of the network comparisons between the various fibrinolytics. P-score analysis showed that tenecteplase had the highest probability of being the best strategy for ENI (p-score=0.94), followed by reteplase and alteplase. No fibrinolytic therapy was associated with the lowest probability of mortality at 90 days, followed by alteplase and tenecteplase.

Conclusions

Among patients with AIS and TIA, tenecteplase demonstrates superior efficacy in achieving ENI when compared with alteplase and no fibrinolytic therapy. It also has the highest probability of being the most effective strategy for providing ENI compared with other fibrinolytics. Moreover, the risk of ICH and mortality is comparable across all fibrinolytic agents.

Authors/Disclosures
Aisha Rizwan Ahmed, MBBS PRESENTER	Dr. Rizwan Ahmed has nothing to disclose.
Aishwarya Koppanatham, MBBS	Ms. Koppanatham has nothing to disclose.
Mrinal M. Murali Krishna, MBBS	Dr. Murali Krishna has nothing to disclose.
Meghna Joseph, MBBS	Dr. Joseph has nothing to disclose.
Issa Salha, MD, MBBS	Dr. Salha has nothing to disclose.
Rabbia Jabbar, MBBS	Dr. Jabbar has nothing to disclose.
Rafael R. Oliveira	Mr. Oliveira has nothing to disclose.
Sana Ahmed, MD	Dr. Ahmed has nothing to disclose.
Wajid M. Mir, MBBS	Dr. Mir has nothing to disclose.
Jovana Ristic, Medical student	Ms. Ristic has nothing to disclose.
Gokul Rajith, MBBS	Mr. Rajith has nothing to disclose.
Zeeshan Mansuri, MD, MBBS, DM, FSCAI	Dr. Mansuri has nothing to disclose.
Maryam Rizwan, Lab scientist	Mrs. Rizwan has nothing to disclose.
Lubna Al-Sharif, MSc	Ms. Al-Sharif has nothing to disclose.
Natalia Arturo, MD	Ms. Arturo has nothing to disclose.
Paweł Chochoł, MD	Mr. Chochol has nothing to disclose.
Thomas C. Varkey, MD (Banner University Medical Center)	Dr. Varkey has nothing to disclose.

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