Re-examining the exclusion criterion of early recurrent ischemic stroke in intravenous thrombolysis: A meta-analysis

Abstract Background Current guidelines preclude the administration of intravenous tissue plasminogen activator in patients with early recurrent stroke (prior ischemic stroke within three months). Objectives This is a meta-analysis that aimed to determine the safety and efficacy of thrombolysis in patients with early recurrent stroke. Summary of review Pubmed, Cochrane, Scopus, Embase and Clinicaltrials.gov were searched for studies comparing the outcomes of acute ischemic stroke patients undergoing intravenous thrombolysis between those with early recurrent stroke and those without. Random-effects meta-analysis was used to evaluate the outcomes in terms of symptomatic intracranial hemorrhage, mortality and good functional outcomes at 3 months (modified Rankin Score ≤ 2). Three retrospective cohort studies with a total of 48,459 thrombolysed patients (824 with early recurrent stroke and 47,635 without early recurrent stroke) were included in the meta-analysis. There was no significant difference between thrombolysed patients with early recurrent stroke and those without in terms of symptomatic intracranial hemorrhage (Odds Ratio [OR] 1.39, 95% Confidence Interval [CI] 0.75–2.58), mortality (OR 1.36, 95% CI 0.60–3.09) and good functional outcomes at 3 months (OR 0.74, 95% CI 0.47–1.16). Conclusions Patients who received thrombolysis despite early recurrent stroke were not found to be at an increased risk of adverse outcomes compared to patients without early recurrent stroke. Our meta-analysis suggests that there is insufficient evidence to substantiate excluding patients with early recurrent stroke from receiving thrombolysis. Further studies to re-examine early recurrent stroke as an exclusion criterion for receiving thrombolysis are warranted.