Efficacy and Safety of Intravenous Thrombolytics in Ischemic Stroke Beyond the 4.5-Hour Time Window: A Systematic Review and Meta-Analysis.

ABSTRACT: BackgroundStroke significantly impacts global health, and IV thrombolytics such as tenecteplase and alteplase are time sensitive. While they show promise beyond 4.5 h, evidence is inconclusive. This meta-analysis assesses IVT's efficacy and safety past 4.5 h.MethodsPubMed, Cochrane Central, and ScienceDirect were searched till August 2025. The risk ratios (RR) were pooled along with 95% confidence intervals under the random effect model using the Review Manager version 5.4.1.ResultsThirteen randomized trials involving 3602 patients were analyzed. Compared to the control group, IVT significantly improved the rates of excellent (RR = 1.22; 95%CI: [1.13, 1.31];p < 0.00001; I² = 0%) and good (RR = 1.11; 95%CI: [1.06, 1.18];p < 0.0001; I² = 0%) functional outcomes. However

SUBMITTER: Waseem MH 

PROVIDER: S-EPMC12804653 | biostudies-literature | 2026 Jan-Dec

REPOSITORIES: biostudies-literature