Key messages

• For people who received a procedure to open up blood vessels after a stroke, adding a clot-busting medicine:

  • did not make a difference, on average, in their ability to perform daily activities on their own with slight or moderate disability, in the number of deaths, or in bleeding inside the brain with or without symptoms.

  • resulted in a higher flow of blood that could be seen going through the previously blocked blood vessels.

What is acute ischaemic stroke?

In an ischaemic stroke, the blood flow to the brain is decreased by blockage of a blood vessel. If this is not treated quickly, the brain tissue becomes injured, leading to symptoms, such as changes in the ability to speak, move, or walk. In this case, acute means it happened within the past 4.5 hours.

How is acute ischaemic stroke treated?

Treatments for an acute ischaemic stroke include a procedure to open up the blood vessels (endovascular thrombectomy), and clot-busting medicines (intravenous thrombolysis).

What did we want to find out?

We wanted to find out whether giving a clot-busting medicine to people who were receiving an endovascular thrombectomy led to better outcomes than not giving it.

What did we do?

We searched for studies that compared groups of people who received clot-busting medicine to those who did not receive it when they had their endovascular thrombectomy. We compared and summarised the results, and rated our confidence in the evidence, based on factors, such as study methods and sizes.

What did we find?

We found six studies, with a total of 2336 people who just had an ischaemic stroke, and who received a procedure to open up their blood vessels. They were randomised (divided so that everyone had the same chance to receive the medicine) to receive a clot-busting medicine or not receive a clot-busting medicine. The average age was 71 years. There were 1034 women and 1302 men. Both groups had, on average, almost the same level of disability at the beginning of the studies.

People who received a procedure to open up their blood vessels after a stroke and were given a clot-busting medicine did not, on average, do any better than those who did not get the clot-busting medicine, in their ability to perform daily activities on their own with slight or moderate disability, in the number of deaths, or in bleeding inside the brain. However, they did have a higher flow of blood seen going through the blocked blood vessels.

What are the limitations of the evidence?

We are confident that the clot-busting medicine made little or no difference, on average, in moderate disability, the number of deaths, or bleeding inside the brain, without symptoms.

We are also confident that the clot-busting medicine improved the flow of blood that could be seen going through the blocked blood vessels.

We are moderately confident that clot-busting medicine probably made little to no difference, on average, to the ability to perform daily activities on one's own with a slight disability. Our confidence in the evidence is moderate because we had concerns about the wide range of results, and differences between studies.

We are moderately confident that the clot-busting medicine probably made little to no difference in bleeding in the brain, with symptoms. Our confidence in the evidence is only moderate because of our concerns about the wide range of values, which could include a meaningful difference.

How up-to-date is this evidence?

The evidence is up-to-date to November 2023.