Safety and efficacy of repeated thrombolysis with recombinant tissue- type plasminogen activator in early recurrent ischemic stroke: A systematic review

Abstract

Thrombolysis with intravenous tissue- type plasminogen activator (IVtPA) is the only approved treatment for patients with acute ischemic stroke. History of stroke for the past three months is an exclusion criteria set by the National Institute of Neurological Disorders and Stroke study. It is unknown whether repeat IVtPA in early ischemic stroke is associated with higher complication rates. The main objective of this review was to determine the safety and efficacy of repeated thrombolysis in patients who had early recurrent ischemic strokes. MEDLINE by PubMed, CENTRAL by The Cochrane Library, HERDIN, SCOPUS and ClinicalTrials.gov websites were searched in August 2018. All studies reporting the use of repeated IVtPA in patients with early recurrent ischemic strokes were included. Data collected include study design, population characteristics, treatment outcomes (symptomatic hemorrhage, functional status in three months, systemic hemorrhage, anaphylaxis). The review included ten articles with a total of 33 patients. One developed hemorrhagic conversion leading to neurologic deterioration and death. Half of the patients with reported functional status three months after the repeated thrombolysis had no or minimal significant disability. One died from spontaneous rupture of previously unidentified infrarenal aortic aneurysm. No anaphylactic reactions were noted. Repeated IVtPA can be safe and efficacious in patients who had early recurrent ischemic stroke. Larger studies are needed to confirm the beneficial effects and risks of repeated IVtPA in patients with early recurrent ischemic strokes.