Table 1

Summary of included studies

StudyStudy typeNType of fibrinolyticMedian dose (IQR)Median dose in patients after IV tPATimingIA fibrinolytics administered after IV tPAMain indicationMT TechniquesICH definition available
IANon-IARescue after failed or incomplete MTPrimary as conjunction with MT
Anadani et al 17 RO of prospective database67419tPA5 mg (2–6 mg)5 mgN/AYes (13/67, 19.4%)YesNoADAPTNo (PH2 used)
Heiferman et al 21 RO2812tPA13.25 mg (8–15.25 mg)10 mgN/AYes (15/28)NoYesStent-retriever thrombectomyYes
Yi et al 22 RO3756tPANA, reported as <5 mgN/ANot reportedYes (17/37, 45.9%)NoYesStent-retriever thrombectomyYes
Zaidi et al 16 RO3744tPANANANot reportedYes (17/37, 46%)YesNoStent-retriever thrombectomyYes
Kaesmacher et al 33 RO of prospective database100893uPA300000 IU (250000–500000 IU)250000 (250000–500000)Median time to uPA (275 min, IQR 229–313)Yes (43/100, 43%)Yes (75%)Yes (25%)>90% stent-retriever thrombectomyYes
Bracard et al 27 RO of RCT data (THRACE)15124tPA7 mg (3–10 mg)7 mgN/AYes (15/15, 100%)YesNo77.1% stent-retriever thrombectomy
9.3% aspiration
13.6% multiple systems
Berkhemer et al 26 RO of RCTA data (MR CLEAN)22169tPANA, reported as 5 mg single dose, up to 30 mgN/AN/AYes (18/21, 86%, 1 unknown)YesNoStent-retriever thrombectomyYes
Goyal et al 25 RO of RCT data (ESCAPE)7158tPAMedian dose 5 mg (range 1–7 mg)N/AN/AYes (5/7, 71.4%)N/AN/AStent-retriever thrombectomyYes
Castonguay et al 32 RO of a prospective database (STRATIS, MCA occlusions only)92*518*tPAMedian dose 4 mg (IQR 2–10 mg)4 mgN/AYes (66/92, 65.6%)Yes (20%)Yes (75%)Stent-retriever thrombectomyYes
Total9 RO40523928 x tPA, 1 x uPAMedian range tPA 4–13.25 mg51.6% (209/405)>80% stent-retriever8/9 Yes
  • * numbers slightly differ in comparison to the abstract version, because in this meta-analysis, only patient with available data on sICH are included.

  • ESCAPE, Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times; IA, intra-arterial; IV, intravenous; MCA, middle cerebral artery; MRCLEAN, Multicenter Randomized CLinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands; MT, mechanical thrombectomy; N/A, not available; PH2, parenchymal hematoma type 2; RCT, randomized controlled trial; RO, retrospective observational; sICH, symptomatic intracranial hemorrhage; STRATIS, Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke; THRACE, Trial and Cost Effectiveness Evaluation of Intra-arterial Thrombectomy in Acute Ischemic Stroke; tPA, tissue plasminogen activator, alteplase; uPA, urokinase.