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Intravenous thrombolysis in patients with acute ischaemic stroke with history of prior ischaemic stroke within 3 months
  1. Georgios Tsivgoulis1,2,
  2. Aristeidis H Katsanos3,
  3. Peter D Schellinger4,
  4. Martin Köhrmann5,
  5. Thorsten Steiner6,7,
  6. Valeria Caso8,
  7. Lina Palaiodimou1,
  8. Daniel Strbian9,
  9. Niaz Ahmed10,11,
  10. Andrei Alexandrov2,
  11. Sean I Savitz12
  1. 1 Second Department of Neurology, “Attikon” Hospital, National and Kapodistrian University of Athens, Athens, Greece
  2. 2 Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  3. 3 Department of Neurology, University of Ioannina, School of Medicine, Ioannina, Greece
  4. 4 Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
  5. 5 Department of Neurology, Universitätsklinikum Essen, Essen, Germany
  6. 6 Department of Neurology, Frankfurt Hoechst Hospital, Frankfurt, Germany
  7. 7 Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
  8. 8 Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
  9. 9 Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
  10. 10 Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
  11. 11 Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
  12. 12 Neurology, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
  1. Correspondence to Dr Georgios Tsivgoulis, Second Department of Neurology, “Attikon” Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 15344, Greece; tsivgoulisgiorg{at}

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Current guidelines from the American Heart Association/American Stroke Association advocate against the administration of intravenous thrombolysis (IVT) in patients with acute ischaemic stroke (AIS) with a prior ischaemic stroke (IS) within 3 months (Class III: Level of Evidence B).1 This concern is based on a presumed increased risk of symptomatic intracranial haemorrhage (sICH) and mortality2 and therefore led to the respective guideline recommendation. Thus, patients with a history of prior IS have been excluded in the majority of the pivotal randomised controlled clinical trials that have established IVT as a treatment for AIS.2

However, the rationale for excluding patients with a history of IS within the prior 3 months in the aforementioned trials was not based on pathophysiological considerations but instead on information extrapolated from the relevant recommendations for IVT in myocardial infarction.2 In the present systematic review and meta-analysis, we sought to compare the safety and efficacy of IVT treatment between patients with AIS with a history of previous IS within 3 months and patients with AIS but without a history of previous IS within 3 months from the index event.


This meta-analysis is presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses.

From eligible studies, we extracted data on the primary safety outcomes of sICH (according the definition used in each study) and in-hospital or 3-month mortality. We also evaluated the following efficacy outcomes: early neurological improvement (ENI) at 24 hours (according to the definition used in each study), 3-month favourable functional outcome (FFO, modified Rankin Scale (mRS) scores 0–1), 3-month functional …

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  • Contributors GT and AHK: drafting the manuscript, data extraction, analysis and interpretation of the results. PDS, MK, TS, VC, DS, NA and AVA: revision of the manuscript. LP: revision of the manuscript, data extraction. SS: revision of the manuscript, study supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.