Efficacy And Safety Of Low-dose And Standard-dose Of Alteplase In Intravenous Thrombolysis Of Acute Ischemic Stroke In Chinese:Meta-analysis

Objective:In this study,Meta-analysis was to compare the differences of efficacy and safety between low-dose and standard-dose of alteplase by searching literatures of low-dose and standard-dose of alteplase in the treatment of acute ischemic stroke for Chinese in recent years.Methods:The literatures published by Pubmed,China Knowledge Network(CNKI)and Wanfang Database from January 2006 to May 2018 were searched.The keywords in English were "recombinant tissue-type plasminogen activator","alteplase","rt-PA","acute ischemic stroke" and "stroke".The Chinese keywords were "recombinant tissue-type plasminogen activator","alteplase","acute ischemic stroke" and "cerebral infarction".The patients were divided into two groups according to the dose of alteplase: low-dose group(0.6 mg/kg)and standard-dose group(0.9 mg/kg).All randomized controlled trials of standard-dose and low-dose of alteplase in the treatment of acute ischemic stroke for Chinese were enrolled in this study,and the relevant data was extracted.The quality of the literature’ evaluation and the data analysis by Rev Man 5.3 software.Results:A total of 10 studies were included in this Meta-analysis.The results showed that:(1)Variation of NIHSS score before and after treatment: There was no significant difference between low-dose group and standard-dose group(SMD=0.27,95% CI:-0.73~0.07,P=0.11).(2)The total effective rate: There was no significant difference between low-dose group and standard-dose group(OR=1.52,95% CI:0.85~2.71,P= 0.15).(3)Variation of m RS score after 90 days:There was no significant difference between low-dose group and standard-dose group(SMD=-0.44,95% CI:-1.35-0.48,P=0.35).(4)The good prognosis rate: There was significant difference between low-dose group and standard-dose group(OR=1.54,95% CI: 1.19-1.99,P=0.001).The good prognosis rate of standard-dose group was higher than that of low-dose group.(5)The rate of cerebral hemorrhage: There was no significant difference between low-dose group and standard-dose group(OR = 1.27,95% CI:0.69-2.34,P = 0.44).(6)The Mortality within 90 days: There was no significant difference between low-dose group and standard-dose group(OR=0.81,95% CI:0.48-3.37,P = 0.41).Conclusion:1.The low-dose of alteplase was the same as the standard-dose of alteplase in variation of NIHSS score before and after treatment,Variation of m RS score after 90 days and the total effective rate,but intravenous thrombolysis with standard-dose of alteplase was more effective in improving the good prognosis rate.2.The rate of cerebral hemorrhage and mortality between low-dose alteplase and standard-dose alteplase was equal.