t-pa trial summary

Acute coronary syndrome

All type of patients: 10 trials - Nicklas - Gold - Williams - Freeman - van der Brand - charbonnier - Ardissino - TIMI 3B - Topol - TIMI 3A

t-PA vs placebo

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
Deaths or MI	no data
In hospital death or MI	no data
In-hospital death	1.51 [0.36 6.38]	p=1.00	0	217	5	Nicklas,Williams,Freeman,Ardissino,Topol,
myocardial infarction (fatal and non fatal)	1.14 [0.44 2.95]	p=1.00	0	237	5	Nicklas,Williams,Freeman,van der Brand,Ardissino,
All cause death	1.00 [0.06 16.65]	p=1.00	0	70	1	Freeman,
Bleeding	2.83 [0.96 8.32]	p=1.00	0	103	2	Williams,van der Brand,

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

Acute myocardial infarction

>6h from onset of symptoms: 2 trials - LATE - TAMI 6

t-PA vs placebo

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	0.91 [0.79 1.05]	p=1.00	0	5908	2	LATE,TAMI 6,
reinfarction	0.63 [0.15 2.72]	p=1.00	0	197	1	TAMI 6,
Cardiovascular death	no data
Long term death	1.26 [0.52 3.07]	p=1.00	0	197	1	TAMI 6,
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	no data
Major bleeding	0.79 [0.17 3.62]	p=1.00	0	197	1	TAMI 6,

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

See more clinical conditions

All type of patients: 19 trials - GUSTO tPA Hiv - ASSET - GISSI II - International Study Group - COBALT - ISIS III (SK/tPA) - Centre Illinois - Cherng - ECSG - PAIMS - TIMI-1 - White - KAMIT - LATE - TAMI 6 - TAMI 5 (t-PA vs uroK) - TAPS - RAAMI - TIMI 4

accelerated t-PA vs APSAC

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	no data
reinfarction	no data
Cardiovascular death	no data
Long term death	no data
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	no data
Major bleeding	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

accelerated t-PA vs streptokinase

No demonstrated result

suggested short term death by 14% (not demonstrated)

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	0.86 [0.78 0.95]	p=0.04	0	30647	1	GUSTO tPA Hiv,
reinfarction	no data
Cardiovascular death	no data
Long term death	no data
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	no data
Major bleeding	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

accelerated t-PA vs t-PA

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	1.65 [0.63 4.33]	p=1.00	0	281	1	RAAMI,
reinfarction	no data
Cardiovascular death	no data
Long term death	no data
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	0.32 [0.03 3.13]	p=1.00	0	281	1	RAAMI,
Major bleeding	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

bolus t-PA vs accelerated t-PA

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	1.06 [0.89 1.26]	p=1.00	0	7169	1	COBALT,
reinfarction	no data
Cardiovascular death	no data
Long term death	no data
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	1.25 [0.88 1.79]	p=1.00	0	7169	1	COBALT,
Major bleeding	1.09 [0.61 1.95]	p=1.00	0	7169	1	COBALT,

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

t-PA vs placebo

No demonstrated result

Major bleeding by 136% (harmful effect)

suggested short term death by 15% (not demonstrated)

suggested Long term death by 20% (not demonstrated)

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	0.85 [0.75 0.95]	p=0.04	0	10919	3	ASSET,LATE,TAMI 6,
reinfarction	0.63 [0.15 2.72]	p=1.00	0	197	1	TAMI 6,
Cardiovascular death	no data
Long term death	0.80 [0.68 0.95]	p=0.04	0	5208	2	ASSET,TAMI 6,
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	1.11 [0.65 1.91]	p=1.00	0	5011	1	ASSET,
Major bleeding	2.36 [1.29 4.31]	p=0.04	0	5208	2	ASSET,TAMI 6,

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

t-PA vs streptokinase

No demonstrated result

suggested Major bleeding by 18% (not demonstrated)

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	1.03 [0.97 1.09]	p=1.00	0	61936	9	GISSI II,International Study Group,ISIS III (SK/tPA),Centre Illinois,Cherng,ECSG,PAIMS,TIMI-1,White,
reinfarction	0.46 [0.11 1.86]	p=1.00	0	122	1	Cherng,
Cardiovascular death	no data
Long term death	1.02 [0.96 1.07]	p=1.00	0	48294	2	International Study Group,ISIS III (SK/tPA),
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	1.03 [0.88 1.20]	p=1.00	0	60797	4	GISSI II,International Study Group,ISIS III (SK/tPA),Cherng,
Major bleeding	0.82 [0.69 0.97]	p=0.04	0	61910	9	GISSI II,International Study Group,ISIS III (SK/tPA),Centre Illinois,Cherng,ECSG,PAIMS,TIMI-1,White,

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

t-PA vs urokinase

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	no data
reinfarction	no data
Cardiovascular death	no data
Long term death	no data
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	no data
Major bleeding	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

t-PA half dose vs t-PA

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	no data
reinfarction	0.11 [0.01 2.05]	p=1.00	0	216	1	KAMIT,
Cardiovascular death	no data
Long term death	no data
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	no data
Major bleeding	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

Late reperfusion: 2 trials - LATE - TAMI 6

t-PA vs placebo

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
short term death	0.91 [0.79 1.05]	p=1.00	0	5908	2	LATE,TAMI 6,
reinfarction	0.63 [0.15 2.72]	p=1.00	0	197	1	TAMI 6,
Cardiovascular death	no data
Long term death	1.26 [0.52 3.07]	p=1.00	0	197	1	TAMI 6,
Haemmorhagic stroke	no data
stroke (fatal and non fatal)	no data
Major bleeding	0.79 [0.17 3.62]	p=1.00	0	197	1	TAMI 6,

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

Cardiac arrest

All type of patients: 1 trials - Abu-Laban

t-PA vs placebo

No demonstrated result

Endpoint	TE [95% CI]	p val	I2	n	k	trials
Survival to hospital discharge	2.97 [0.12 73.78]	p=1.00	0	233	1	Abu-Laban,
Return of spontaneous circulation	0.92 [0.50 1.70]	p=1.00	0	233	1	Abu-Laban,
Death before hospital discharge	NaN [NaN NaN]	p=1.00	0	233	1	Abu-Laban,
Death before hospital admission	no data
Failure of return of spontaneous circulation	1.02 [0.55 1.90]	p=1.00	0	233	1	Abu-Laban,
All cause death	NaN [NaN NaN]	p=1.00	0	233	1	Abu-Laban,
ischemic stroke	no data
intracranial hemorrhage	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

Venous thrombosis

All type of patients: 6 trials - Goldhaber (tPA alone) - Schweizer (local tPA) - Turpie - Verhaeghe (high dose) - Goldhaber (tPA+heparin) - Verhaeghe (low dose)

tPA vs no fibrinolysis

No demonstrated result

suggested Any improvement in venous patency (early) by 174% (not demonstrated)

Endpoint	TE [95% CI]	p val	I2	n	k	trials
Mortality (early)	no data
Pulmonary embolism (early)	no data
Bleeding (early)	2.12 [0.48 9.42]	p=1.00	0	148	2	Goldhaber (tPA alone),Turpie,
Any improvement in venous patency (early)	2.74 [1.20 6.27]	p=0.04	0	147	2	Goldhaber (tPA alone),Turpie,
Complete clot lysis (early)	no data
Stroke/intracerebral bleeding (early)	1.02 [0.02 52.88]	p=1.00	0	83	1	Turpie,
Leg ulceration (late)	no data
Mortality (late)	no data
Post-thrombotic syndrome (late)	no data
Complete clot lysis (late)	no data
Normal venous function (late)	no data

TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients

T-pa fibrinolysis

Acute coronary syndrome

Acute myocardial infarction

Cardiac arrest

Venous thrombosis