Comparison of responses to activase versus actilyse in acute ischaemic stroke

Tan, J., Fulton, R., Abdul-Rahim, A. and Lees, K. (2014) Comparison of responses to activase versus actilyse in acute ischaemic stroke. In: Glasgow Evidence-Based Medicine Society Conference 2013, Glasgow, UK, 5 Oct 2013, e43. (doi: 10.1177/0036933013518464)

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Introduction<p></p> Alteplase is the treatment of choice in acute ischaemic stroke. It is licensed in two forms: ‘Activase’, within 3 h of stroke onset in North America, and ‘Actilyse’, within 4.5 h of stroke onset in Europe.<p></p> Aim<p></p> To investigate for differences between Activase and Actilyse.<p></p> Methods<p></p> There were two components: a systematic review and a retrospective analysis of the Virtual International Stroke Trials Archive (VISTA). (1) We searched for randomised trials of alteplase versus control in stroke, myocardial infarction/unstable angina (MI/UA) and pulmonary thrombo-embolism (PTE). We assigned trials as Activase or Actilyse, estimated the summary odds ratios (ORs), 95% CI and used the Cochran's Q test to assess heterogeneity. (2) We extracted data from VISTA and categorised it as Activase or Actilyse, matched the data and used ORs to express extent of improved outcome in association with alteplase versus controls and p values to express significance of association between Activase and Actilyse. We used adjusted Cochran–Mantel–Haenszel test, proportional odds logistic regression analysis and the Cochran's Q test.<p></p> Results<p></p> (1) 28 trials were analysed and a comparison between Activase and Actilyse was done across eight different outcomes. None of the resulting heterogeneity p values were of a significant value (p = 0.43, 0.65, 0.42, 0.61, 0.69, 0.23, 0.61, 0.17), implying no significant difference. (2) Data were available from 5724 patients (1754 Activase and 3970 Actilyse). After analyses, the heterogeneity p value comparing Activase with Actilyse was found to be significant (p < 0.01).<p></p> Conclusion<p></p> Results from the systematic review and VISTA analysis differ. However, of the two, the former would be more reliable.

Item Type:Conference Proceedings
Glasgow Author(s) Enlighten ID:Macisaac, Dr Rachael and Lees, Professor Kennedy and Abdul-Rahim, Dr Azmil
Authors: Tan, J., Fulton, R., Abdul-Rahim, A., and Lees, K.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Scottish Medical Journal
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