Article Figures & Data
Tables
- Table 1
Intravenous tPA trials for acute ischaemic stroke as listed by the year of publication
Year RCT study Time window Group Conclusion 1995 NINDS5 0–3 hours Placebo versus IV tPA 0.9 mg/kg Improvement of the clinical outcomes at 3 months ECASS32 0–3 hours Placebo versus IV tPA 1.1 mg/kg Improvement of the 90 days’ outcome with increased risk of haemorrhage in particular subgroup 1998 ECASS 2140 0–6 hours Placebo versus IV tPA 0.9 mg/kg No improvement of the 90-day clinical outcomes 1999 ATLANTIS B141 3–5 hours Placebo versus IV tPA 0.9 mg/kg No improvement of the 90-day outcome with increased risk of haemorrhage 2000 ATLANTIS A142 0–6 hours Placebo versus IV tPA 0.9 mg/kg No improvement of the 90-day clinical outcomes with increased haemorrhage and mortality risk 2008 ECASS 3143 3–4.5 hours Placebo versus IV tPA 0.9 mg/kg Improvement of the 90-day outcome with increased risk of haemorrhage 2016 ENCHANTED144 0–4.5 hours IV tPA 0.6 mg/kg versus 0.9 mg/kg The incidence of disability did not achieve non-superiority versus standard dose. Less safety concerns All trials used mRS 0–1 as their efficacy outcome measure.
ATLANTIS, Alteplase Thrombolysis for Acute Non-interventional Therapy in Ischemic Stroke; ECASS, European Cooperative Acute Stroke Study; ENCHANTED, Enhanced Control of Hypertension and Thrombolysis Stroke Study; IV, intravenous; mRS, modified Rankin Scale; NINDS, National Institute of Neurological Disorders and Stroke; tPA, tissue plasminogen activator.
- Table 2
List of other intravenous thrombolytic drugs
Agent Mechanism Trial Implication Results Urokinase (UK) Directly act on fibrinogen UK37 UK 1.5 million IU group (n=155), UK 1 million IU group (n=162, placebo group (n=148) Thrombolysis was safe and effective Tenecteplase More specific binding of fibrinogen to plasminogen into plasmin ATTEST145 Tenecteplase and tPA group (n=52, respectively) Onset within 4.5 hour in patients with AIS treated with tenecteplase and alteplase had similar neurological and imaging outcome TEMPO-1146 Tenecteplase (0.1 mg/kg and 0.25 mg/kg group (n=25 respectively) Onset within 12 hours in patients with mild AIS (NIHSS ≤5 min) with intracranial artery occlusion. Better outcome in 0.25 mg/kg group. Desmoteplase Very strong fibrinolytic activity DIAS-3147 Desmoteplase group (n=247), placebo group (n=245) Onset within 3–9 hours in patients with AIS with cerebral artery occlusion or high-grade stenosis
No better outcome in desmoteplase group but less safety issue.ATTEST, Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis; DIAS, Desmoteplase in Acute Ischemic Stroke; NIHSS, National Institution of Health Stroke Scale; TEMPO, TNK–Tissue-Type Plasminogen Activator Evaluation for Minor Ischemic Stroke with Proven Occlusion; UK, urokinase.
