Trial reportStroke2016
Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes: A Pooled Analysis of 9 Trials.
Open access · bronzeAbstract readRandomized Controlled Trial
In one paragraph
Trial report in Stroke, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 109 papers, 15 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
109citing papers in PubMed, 15 pooled it
16.4field-weighted citation impact, top 1% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
109 citing papers in PubMed, 15 syntheses or guidelines pooled it, 248 citations in OpenAlex.
- To Bridge or Not to Bridge? A Meta-Analysis of Intravenous Thrombolysis Before Thrombectomy in Large Ischemic Core Strokes.Brain and behavior · 2025Pooled it
- A methodological assessment of randomization integrity in alteplase for acute ischemic stroke individual patient data meta-analyses.PloS one · 2025Pooled it
- Intravenous thrombolysis versus dual antiplatelet therapy for patients with acute minor ischaemic stroke: a systematic review and meta-analysis.Frontiers in pharmacology · 2024Pooled it
- Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: executive summary and 2023 update.Stroke and vascular neurology · 2023Guideline
- Safety and efficacy of intravenous thrombolysis in patients with acute ischemic stroke taking direct oral anticoagulants prior to stroke: a meta-analysis.Journal of neurology · 2023Pooled it
- Different doses of tenecteplase vs. alteplase for acute ischemic stroke within 4.5 hours of symptom onset: a network meta-analysis of randomized controlled trials.Frontiers in neurology · 2023Pooled it
- Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis.Acta neurologica Scandinavica · 2022Pooled it
- Thrombectomy with or without thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis.Journal of neurology · 2022Pooled it
- Comparison of Mobile Stroke Unit With Usual Care for Acute Ischemic Stroke Management: A Systematic Review and Meta-analysis.JAMA neurology · 2022Pooled it
- Alteplase for Acute Ischemic Stroke in Patients Aged >80 Years: Pooled Analyses of Individual Patient Data.Stroke · 2020Pooled it
- Induced neuroprotection by remote ischemic perconditioning as a new paradigm in ischemic stroke at the acute phase, a systematic review.BMC neurology · 2020Pooled it
- Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society.Neurologia medico-chirurgica · 2019Guideline
- Thrombolysis Following Heparin Reversal With Protamine Sulfate in Acute Ischemic Stroke: Case Series and Literature Review.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2019Pooled it
- Pooled it
- Comparing Efficacy and Safety of Dual Antiplatelet Therapy versus Intravenous Thrombolytics in Acute Minor Ischemic Stroke: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Prehospital neuroprotectant in combination with post-arrival thrombolytic therapy for acute ischemic stroke. Secondary analysis of the FAST-MAG prehospital trial.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2026Trial
- Intravenous tenecteplase compared with alteplase for minor ischaemic stroke: a secondary analysis of the AcT randomised clinical trial.Stroke and vascular neurology · 2024Trial
- Time to treatment and disability attributed to index stroke in the POINT trial.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2024Trial
- Cerebral Microbleeds and Treatment Effect of Intravenous Thrombolysis in Acute Stroke: An Analysis of the WAKE-UP Randomized Clinical Trial.Neurology · 2022Trial
- Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study.Stroke and vascular neurology · 2021Trial
49 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors at 5 institutions in 3 countries.
Kennedy R LeesFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Jonathan EmbersonFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Lisa BlackwellFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Erich BluhmkiFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Stephen M DavisFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Geoffrey A DonnanFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
James C GrottaFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Markku KasteFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Rüdiger von KummerFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Maarten G LansbergFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Richard I LindleyFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Patrick LydenFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Gordon D MurrayFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Peter A G SandercockFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Danilo ToniFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Kazunori ToyodaFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Joanna M WardlawFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
William N WhiteleyFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Colin BaigentFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
Werner HackeFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.).
George HowardFrom the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (K.R.L.); Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, United Kingdom (J.E., L.B., C.B.); Statistics Department, Boehringer Ingelheim, Germany (E.B.); Melbourne Brain Centre, The Royal Melbourne Hospital and University of Melbourne, Australia (S.M.D.); Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia (G.A.D.); Mobile Stroke Unit and Stroke Research Program, Memorial Hermann Hospital, Houston, TX (J.C.G.); Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland (M.K.); Department of Neuroradiology, Technische Universität, Dresden, Germany (R.v.K.); Stanford Stroke Center, Palo Alto, CA (M.G.L.); Discipline of Medicine, Westmead Hospital Clinical School, George Institute for Global Health, University of Sydney, NSW, Australia (R.I.L.); Department of Neurology, Cedars-Sinai, Los Angeles, CA (P.L.); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, United Kingdom (G.D.M.); Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (P.A.G.S., J.M.W., W.N.W.); Department of Neurology and Psychiatry, Sapienza University of Rome, Italy (D.T.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (K.T.); Department of Neurology, University of Heidelberg, Im Neuenheimer Feld, Germany (W.H.); and Department of Biostatistics, UAB School of Public Health, Birmingham, AL (G.H.). ghoward@uab.edu.
Stroke Thrombolysis Trialists’ Collaborators Group
Heatherwood Hospital · GBHelsinki University Hospital · FIParsons (United States) · USSt. Clare Hospital in Lakewood · USSt. Gregory's University · US
Funding
British Heart Foundation CH/1996001/9454Medical Research Council G0400069Medical Research Council G0902303Medical Research Council MC_U137686849Medical Research Council MR/K026992/1
Abstract
backgroundThrombolytic therapy with intravenous alteplase within 4.5 hours of ischemic stroke onset increases the overall likelihood of an excellent outcome (no, or nondisabling, symptoms). Any improvement in functional outcome distribution has value, and herein we provide an assessment of the effect of alteplase on the distribution of the functional level by treatment delay, age, and stroke severity.
methodsPrespecified pooled analysis of 6756 patients from 9 randomized trials comparing alteplase versus placebo/open control. Ordinal logistic regression models assessed treatment differences after adjustment for treatment delay, age, stroke severity, and relevant interaction term(s).
resultsTreatment with alteplase was beneficial for a delay in treatment extending to 4.5 hours after stroke onset, with a greater benefit with earlier treatment. Neither age nor stroke severity significantly influenced the slope of the relationship between benefit and time to treatment initiation. For the observed case mix of patients treated within 4.5 hours of stroke onset (mean 3 hours and 20 minutes), the net absolute benefit from alteplase (ie, the difference between those who would do better if given alteplase and those who would do worse) was 55 patients per 1000 treated (95% confidence interval, 13-91; P=0.004).
conclusionsTreatment with intravenous alteplase initiated within 4.5 hours of stroke onset increases the chance of achieving an improved level of function for all patients across the age spectrum, including the over 80s and across all severities of stroke studied (top versus bottom fifth means: 22 versus 4); the earlier that treatment is initiated, the greater the benefit.
Indexed as
AgedAged, 80 and overBrain IschemiaFemaleFibrinolytic AgentsHumansMaleMiddle AgedSeverity of Illness IndexStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeFibrinolytic AgentsTissue Plasminogen Activatorconfidence intervalodds ratiostrokethrombolytic therapyUnited States
Identifiers
What OpenQuestion holds
Textmetadata
LicenceTDM
Read underepoch 390
Registered trials
None linked
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.