Clinical outcomes after intravenous thrombolysis for acute ischemic stroke in low- and middle-income countries: a pooled analysis of 67,917 patients and systematic review.
Neurological Research · 2026-10-11 · Systematic review
Abstract
INTRODUCTION: Stroke is a leading cause of disability and mortality worldwide. Patients in low- and middle-income countries (LMICs) are disproportionately affected, yet thrombolysis outcomes in these settings are underexplored. METHODS: We searched PubMed, Embase, Scopus, Web of Science, and Global Index Medicus through April 2024. Outcomes were 90-day functional independence (mRS 0-2), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Risk of bias used Cochrane RoB 2 and ROBINS-I; random-effects meta-analyses estimated pooled proportions with I2. RESULTS: Of 1,865 records screened, 79 studies (67,917 patients; 24 countries) were included. Most used alteplase; others examined tenecteplase, recombinant prourokinase, or reteplase; eight compared low- vs standard-dose alteplase. Pooled estimates were functional independence 63% (95% CI, 58-67), sICH 4% (95% CI, 3-5), and mortality 8% (95% CI, 6-10). Functional independence was similar across continents; sICH was lowest in Asia, mortality lowest in Africa. Heterogeneity was high, partly explained by baseline stroke severity and study size. Overall risk of bias was low to moderate. CONCLUSIONS: Standard-dose thrombolysis within 4.5 hours in LMICs shows efficacy and safety comparable to reports from high-income countries, with regional variation in safety and mortality. These results support broader implementation of thrombolysis in resource-limited settings to reduce global stroke disparities.
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Tags
Antithrombotics & thrombolytics · Low- and middle-income settings · Mortality & survival · Quality of life & function · Thrombolytics
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