Neurology: The venous thrombosis time window is expected to be expanded to 11 hours?

Current guidelines from the American Heart Association and the American Stroke Association recommend that attepas (IVTs) (IVT) (Class III, evidence level B) should not be used in patients with acute ischemic stroke (AIS) whose onset time is unclear or uncertain, or whose AIS duration is more than 4.5 hourshowever, well-documented evidence suggests that the use of proven advanced neuroimaging techniques can guide the selection of suitable AIS patients, regardless of the length of time and shortness of symptoms, who are expected to derive maximum benefit from re-injection therapythe results of their meta analysis were published in Neurology, Greece, in March 2020, by Georgios Tsivgoulis, and others from Greece, to evaluate patients who had an unknown duration of onset or had an incidence of more than 4.5h of the disease screen, and who had given the efficacy of venous thrombosisresearchers conducted a random effect meta risk to evaluate the relationship between venous thrombosis (IVT, 0.9mg/kg) and prognosis (unadjusted and adjusted confusion factors), and the methods for evaluating prognosis include: 3 months of good functional prognosis (a) e functional, FFO; mRS 0-1), 3 months functionalindependent (functional independence, FI; mRS 0-2), 3 month mortality, 3 months functional improvement (mRS sequence analysis), sICH and complete re-pass (complete re-use, CR)included a total of 4 randomized clinical trials (859 cases), including ECASS IV, EXTEND (average time from last looks normal to tPA push 7.2h (IQR, 6.2-8.1), Michel (9.4h (IQR, 6.5-13.4) and WAKE-UP (10.3h(IQR, 8.1-12),) the characteristics of the studies are shown below:in unadjusted analysis, IVT vshigher 3 months FFO (OR 1.48, 95% CI 1.12-1.96), FI (OR 1.42), 95% CI 1.07-1.90), sICH (OR 5.28, 95% CI 1.35-20.68) and CR (OR 3.29, 95% CI 1.90-5.69) probability, no significant difference in the proportion of 3 months of total risk of death (OR 1.75, 95% CI 0.93 - 3.29)。in adjustment analysis, IVT is also associated with the possibility of higher 3-month FFO (ORadj 1.62, 95% CI 1.20-2.20), functional improvement (ORadj 1.42, 95% CI 1.11-1.81) and sICH (ORadj 6.22, 95% CI 1.37-28.26)IVT is independent of 3-month FI (ORadj 1.61, 95% CI 0.94-2.75) and all-cause death (ORadj 1.75, 95% CI 0.93-3.29)There is no obvious evidence of heterogeneity in any analysisthe final authors concluded that patients with AIS who had an unknown time of onset or a symptom attack of 4.5 hours were more likely to have full re-pass and improve function at 3 months, despite an increased risk of sICH, for patients with advanced neuroimaging techniquesat the same time, the authors believe that the system review and meta analysis for the first time confirmed the strong evidence of the benefits of venous thrombosis in patients with the incidence of 5h to 11h, proving that there is an ischemic core-semi-dark band mismatch or FLAIR-DWI mismatch baseline neuroimaging expression can benefit from venous thrombosis treatment