SynthesisStroke2020
Alteplase for Acute Ischemic Stroke in Patients Aged >80 Years: Pooled Analyses of Individual Patient Data.
Synthesis in Stroke, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 5 of them syntheses that pooled it.
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
39 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Preclinical studies of conditioned medium of hypoxic-preconditioned mesenchymal stem cell/hypMSC-CM for ischemic stroke: A systematic review.Open veterinary journal · 2026Pooled it
- Efficacy and Safety of Tenecteplase in Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials.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
- Chinese Stroke Association guidelines for clinical management of ischaemic cerebrovascular diseases: executive summary and 2023 update.Stroke and vascular neurology · 2023Guideline
- Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis.Acta neurologica Scandinavica · 2022Pooled it
- Age Is an Effect Modifier of Thrombectomy Benefit in a Socioeconomically Vulnerable Stroke Population.Annals of neurology · 2026Trial
- Tenecteplase versus alteplase for acute ischaemic stroke in the elderly patients: a post hoc analysis of the TRACE-2 trial.Stroke and vascular neurology · 2025Trial
- Efficacy and safety analysis of tenecteplase vs. alteplase in very elderly patients with acute ischemic stroke: a systematic review and meta-analysis of randomized trials.Internal and emergency medicine · 2026Article
- Real-World Outcomes of Ischemic Stroke Interventions in Older Patients: A Cohort Study from a Tertiary Medical Center.Healthcare (Basel, Switzerland) · 2026Article
- ANGWC Nomogram for Predicting Poor 3-month Outcome after Intravenous Thrombolysis in Young and Middle-Aged Patients with First-Ever Stroke.Thrombosis and haemostasis · 2026Article
- Spatiotemporal analysis of hospitalizations, mortality and access to intravenous thrombolysis for ischemic stroke in Southern Brazil.BMC public health · 2026Article
- Effectiveness of intravenous recombinant plasminogen activator treatment in Chinese patients with acute ischaemic stroke aged over 80 years: a retrospective cohort study.Stroke and vascular neurology · 2026Article
- Knowledge of stroke warning signs, attitudes to emergency activation, and help-seeking practices among adults in a hospital catchment: a single-center KAP study.Frontiers in public health · 2026Article
- Machine Learning-Based Risk Stratification for Symptomatic Intracranial Hemorrhage and 3-Month Prognosis following Intravenous Thrombolysis.Cerebrovascular diseases extra · 2026Article
- Characteristics, temporal trends and outcomes of intravenous thrombolysis in Chinese patients aged>80 years who had a stroke.Stroke and vascular neurology · 2025Observational
- Barriers to Early Hospital Presentation in Acute Stroke: Findings from a Cohort Study.Annals of Indian Academy of Neurology · 2025Article
- Article
- Observational
- Risk prediction model for poor prognosis after intravenous thrombolysis among ischemic stroke patients aged ≥ 80 years and analysis of follow-up.Scientific reports · 2025Article
- Safety of alteplase intravenous thrombolysis and influencing factors of clinical outcome in elderly patients with acute ischemic stroke.BMC neurology · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background/purposeExpert guidelines specify no upper age limit for alteplase for thrombolysis of acute ischemic stroke (AIS) but, until recently, European regulatory criteria restricted its use to patients aged 18 to 80 years. We performed pooled analyses of randomized controlled trial (RCT) and registry data to evaluate the benefit-risk profile of alteplase for AIS among patients aged >80 years to support a regulatory application to lift the upper age restriction.
methodsIndividual patient data were evaluated from 7 randomized trials of alteplase (0.9 mg/kg) versus placebo or open control for AIS, and the European SITS-UTMOST registry database. Clinical outcomes, including good functional outcome (score 0-1, modified Rankin Scale day 90 or Oxford Handicap Score day 180), were evaluated in the full RCT and registry populations, and specified age-based subgroups (≤80 or >80 years) who met existing European regulatory criteria for alteplase, excluding upper age restriction.
resultsRegardless of treatment allocation, 90-day mortality was lower among RCT patients aged ≤80 versus >80 years who otherwise met existing European regulatory criteria (246/2405 [10.2%] versus 307/1028 [29.9%], respectively). Among patients aged >80 years, alteplase versus placebo was associated with a higher proportion of good stroke outcome (modified Rankin Scale score 0-1; 99/518 [19.1%] versus 67/510 [13.1%];
conclusionsAlteplase for AIS has a positive benefit-risk profile among patients aged >80 years when administered according to other regulatory criteria. Alteplase for AIS should be evaluated on an individual benefit-risk basis.
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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.