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2014 ; 93
(28
): e286
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Renal dysfunction and thrombolytic therapy in patients with acute ischemic
stroke: a systematic review and meta-analysis
#MMPMID25526464
Hao Z
; Yang C
; Liu M
; Wu B
Medicine (Baltimore)
2014[Dec]; 93
(28
): e286
PMID25526464
show ga
Renal dysfunction is a prevalent comorbidity in acute ischemic stroke patients
requiring thrombolytic therapy. However, the effect of renal dysfunction on the
clinical outcome of this population remains controversial. This study aimed to
evaluate the safety and effectiveness of thrombolytic therapy in acute stroke
patients with renal dysfunction using a meta-analysis. We systematically searched
PubMed and EMBASE for studies that evaluated the relationship between renal
dysfunction and intravenous tissue plasminogen activator (tPA) in patients with
acute ischemic stroke. Poor outcome (modified Rankin Scale?2), mortality, and
symptomatic intracranial hemorrhage (ICH) and any ICH were analyzed. Fourteen
studies were included (N=53,553 patients). The mean age ranged from 66 to 75
years. The proportion of male participants was 49% to 74%. The proportion of
renal dysfunction varied from 21.9% to 83% according to different definitions.
Based on 9 studies with a total of 7796 patients, the meta-analysis did not
identify a significant difference in the odds of poor outcome (odds ratio
[OR]=1.06; 95% confidence interval [CI]: 0.96-1.16; I=44.5) between patients with
renal dysfunction and those without renal dysfunction. Patients with renal
dysfunction were more likely to die after intravenous thrombolysis (OR=1.13; 95%
CI: 1.05-1.21; I=70.3). No association was observed between symptomatic ICH
(OR=1.02; 95% CI: 0.94-1.10; I=0) and any ICH (OR=1.07; 95% CI: 0.96-1.18;
I=25.8). Renal dysfunction does not increase the risk of poor outcome and ICH
after stroke thrombolysis. Renal dysfunction should not be a contraindication for
administration of intravenous thrombolysis to eligible patients.
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