Risk of Early Recurrent Stroke and Thrombotic Events After Reperfusion Therapy in Acute Ischemic Stroke: A Meta-Analysis
Bibliographic record
Abstract
BACKGROUND: Following an acute ischemic stroke, the risk of recurrent stroke is highest in the first 90 days. It is unclear whether this risk is altered by reperfusion therapy. In this meta-analysis, we aim to evaluate the risk of early recurrent stroke and other nonstroke thrombotic events postreperfusion therapy in acute ischemic stroke. METHODS: In this meta-analysis, randomized controlled trials (RCTs) were included in adults aged 18 years or older with acute ischemic stroke, comparing reperfusion treatment with best medical management (MED). We searched PUBMED, Embase, Cochrane Library, and Web of Science databases. The studies were grouped into endovascular thrombectomy (EVT) versus MED and intravenous thrombolysis versus MED. We performed a meta-analysis using a random-effects model (restricted maximum likelihood) to estimate the log risk ratio (RR) of early recurrent stroke and nonstroke thrombotic events (NSTE)-including myocardial infarction, acute coronary syndrome, deep vein thrombosis, pulmonary embolism, and peripheral embolism-after reperfusion therapy compared with MED at 90 days after symptom onset. This study is registered with PROSPERO (The International Prospective Register of Systematic Reviews). RESULTS: A total of 15 RCTs (n=4898) comparing EVT versus MED observed no difference in early recurrent stroke (5.5%, 143/2618 versus 4.5%, 102/2280; RR, 1.2 [95% CI, 0.9-1.6]). Nine RCTs (n=7193) comparing intravenous thrombolysis versus MED observed no difference in early recurrent stroke (2%, 73/3615 versus 1.8%, 66/3578; RR, 1.1 [95% CI, 0.8-1.5]). Fourteen RCTs (n=4033) comparing EVT versus MED reported NSTE. There was no difference in NSTE in the EVT arm (3.1%, 62/2024 versus 3.1%, 62/2009; RR, 1 [95% CI, 0.7-1.4]). Five RCTs (n=4961) comparing intravenous thrombolysis versus MED observed no difference in NSTE (2%, 51/2479 versus 2.2%, 54/2482; RR, 0.9 [95% CI, 0.6-1.4]). CONCLUSIONS: Reperfusion therapies (EVT±intravenous thrombolysis) in acute ischemic stroke within 24 hours of symptom onset were not associated with increased recurrent stroke or NSTE within 90 days compared with best medical therapy. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42024542020.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.032 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.019 | 0.076 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".