NEW YORK (Reuters Health) – Intra-arterial fibrinolysis improves outcomes after acute ischemic stroke, a meta-analysis confirms — and although the treatment increases the risk of hemorrhage, that doesn’t translate to increased mortality.

The meta-analysis, which included pooled data from five randomized trials with nearly 400 subjects, is reported by Dr. Jeffrey L. Saver of the UCLA Stroke Center, Los Angeles, and colleagues in the May issue of Stroke.

Compared with controls, patients treated with fibrinolysis were more likely to have good (odds ratio, 2.05) or excellent (OR, 2.05) clinical functional outcomes at 90 days or at trial end. The researchers defined “good” as a modified Rankin scale score of 0 to 2, and “excellent” as a score of 0 to 1.

Rates of good outcomes in treated patients and controls were 42.9% and 28.1%, respectively; rates of excellent outcomes were 31.1% and 18.1%. The number needed to treat was 6.8 for good outcomes and 7.7 for excellent outcomes.

Fibrinolysis patients were also more likely to have only minimal neurologic deficits (National Institutes of Health Stroke Scale score of 0 to 1; OR, 2.24) and minimal impairment of activities of daily living (OR, 1.60). Treatment increased the odds of partial or complete recanalization (OR, 6.42) and complete recanalization (OR, 4.62).

Although fibrinolysis was associated with an increased risk of radiological hemorrhage (OR, 3.37) and symptomatic hemorrhage (OR, 2.87), there was no difference in mortality between fibrinolysis and control patients (20.5% vs 24.0%).

The researchers say these results are “consistent with prior studies indicating that many postfibrinolysis radiological hemorrhages are confined to already-damaged tissue and do not worsen final outcome.”

Formal meta-analysis, they conclude, suggests that the procedure “substantially increases recanalization rates and good and excellent clinical outcomes in acute ischemic stroke.”

Reference:
Stroke 2010.