Outcomes of Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism: A Secondary Analysis of the POST-UK Trial.
Jiaxing Song, Xuexiao Zhao, Gaoming Li et al.
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In 30 seconds
This secondary analysis of the multicenter, randomized POST-UK trial assessed adjunctive intra-arterial urokinase after near-complete to complete reperfusion in patients with acute ischemic stroke due to cardioembolism. Among 209 patients, urokinase was associated with higher odds of disability-free survival at 90 days (modified Rankin Scale score 0–1) than control (adjusted risk ratio, 1.49 [95% CI, 1.08-2.06]; P =0.01). There were no significant between-group differences in 90-day mortality, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours.
Key findings
- Among 209 patients with cardioembolic stroke, 103 received intra-arterial urokinase and 106 were assigned to control.
- Urokinase increased the odds of disability-free survival at 90 days: adjusted risk ratio, 1.49 [95% CI, 1.08-2.06]; P =0.01.
- No significant differences were found in 90-day mortality, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours.
Why it matters
Disability after cardioembolic stroke can persist despite successful endovascular reperfusion. These findings suggest that adjunctive intra-arterial urokinase may improve functional outcomes in patients who achieve near-complete to complete reperfusion, without a detected increase in the reported safety outcomes. The results add evidence for this selected population but do not establish benefit beyond it.
What to keep in mind
This is a secondary analysis of a trial and includes only patients with cardioembolic stroke who achieved near-complete to complete reperfusion, limiting generalisability to other stroke mechanisms or reperfusion outcomes.