Background and Purpose: We performed a meta-analysis to compare the outcomes between lower dose and standard dose intravenous tissue-type plasminogen activator (tPA) for acute ischemic stroke in randomized and non- randomized controlled trials.
Methods: We searched PubMed for relevant studies and calculated pooled odds ratios (ORs) using random effects models.The primary endpoint was good functional outcome[modified Rankin Scale (mRS) of 0-1] at 3 month after stroke onset. Other major end points were all-cause mortality and symptomatic intracerebral haemorrhage (sICH).
Results: From 2010 to 2016, 7 Cohort studies and 1 randomized controlled trial (ENCHANTED trial) were pooled in meta-analysis. The lower tPA strategy was likely to be less effective than the standard dose treatment (OR=0.87; 95% confidence interval [CI], 0.73-1.04, P=0.136; I2 =47.9%, P=0.044 in random effects models and OR=0.88; 95% CI 0.88-0.98,P=0.016 ;I2 =0.0%, P=0.693 in non- random effects models after 2 cohort studies were excluded due to heterogeneity). No difference was found for mortality at 90 days (OR=0.87; 95% CI 0.74-1.03, P=0.102 ;I2 =0.0%, P=0.635 in non-random effects models)and sICH (OR=1.12; 95% CI 0.68-1.83,P=0.659; I2 =57.6%, P=0.016 in random effects models and OR=1.23; 95% CI 0.92-1.65, P=0.168; I2 =0.0%, P=0.547 in non-random effects models after 2 cohort studies were excluded due to heterogeneity ) between lower tPA group and standard dose .
Conclusions: The low-dose alteplase strategy was less effective comparable to the standard-dose treatment .The safety was similar between the two strategies.