Abstract
Background: 25% ischemic strokes are wake-up strokes or unwitnessed daytime strokes and were excluded from thrombolysis due to the unclear-onset time. Whether thrombolysis is effective for these patients based on neuroimaging is still unclear. We performed the first meta-analysis to evaluate the effect of thrombolysis for patients with wake-up stroke or unknown stroke onset. Methods: PubMed, EMBASE, and Cochrane Library were systematically searched to identify studies reported on the association between thrombolysis and wake-up strokes or unwitnessed daytime strokes in May 18, 2018. Randomized controlled trials and retrospective comparative studies that compared the effect of thrombolysis with conventional treatments for wake-up stroke or unclear-onset stroke were eligible and a random-effect model to assess the outcomes. Findings: 11 eligible study including 1551 patients. The control group had lower National Institutes of Health stroke scale score. Intravenous recombinant tissue plasminogen activator for acute wake-up stroke patient resulted in a better functional outcome than control group(p＜0.05). Intracranial hemorrhage of control group were lower than wake-up stroke group. The mortality between both group was not statistically significant difference. Interpretation: Intravenous recombinant tissue plasminogen activator may help to improve clinical prognosis for wake-up stroke. More well-designed RCTs are needed to evaluate the effect of intravenous rt-PA for wake-up patient. Funding: This study was funded by the National Natural Science Foundation of China (No. 81572481)to Y.P., the Science and Technology Program of Guangdong Province (No.2014A020212389) to XP.L, the Key Project of Product, Study and Research of Guangzhou City (No. 201508020058) to Y. P and the Natural Science Foundation of Guangdong Province (No. 2015A030313030) to Xiaoming Rong. Potential Conflicts of Interest: The authors declare that they have no competing interests. Ethics Approval and Consent to Participate: Not applicable.
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