Clinical outcomes after intravenous thrombolysis for acute ischemic stroke in low- and middle-income countries: a pooled analysis of 67,917 patients and systematic review

Carbajal-Galarza M.; Chinchihualpa-Paredes N.O.; Calisaya-Madariaga I.; Vascones F.; Flores-Rodríguez N.; Berrú-Villalobos S.; Pacheco-Barrios N.; Vera D.; Abanto-Perez S.; Guerrero M.; Acurio K.; Abanto C. · Neurological Research (2026) · DOI: 10.1080/01616412.2026.2743171

Resumen

Introduction: Stroke is a leading cause of disability and mortality worldwide. Patients in low- and middle-income countries (LMICs) are disproportionately affected, yet thrombolysis outcomes in these settings are underexplored. Methods: We searched PubMed, Embase, Scopus, Web of Science, and Global Index Medicus through April 2024. Outcomes were 90-day functional independence (mRS 0–2), symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Risk of bias used Cochrane RoB 2 and ROBINS-I; random-effects meta-analyses estimated pooled proportions with I2. Results: Of 1,865 records screened, 79 studies (67,917 patients; 24 countries) were included. Most used alteplase; others examined tenecteplase, recombinant prourokinase, or reteplase; eight compared low- vs standard-dose alteplase. Pooled estimates were functional independence 63% (95% CI, 58–67), sICH 4% (95% CI, 3–5), and mortality 8% (95% CI, 6–10). Functional independence was similar across continents; sICH was lowest in Asia, mortality lowest in Africa. Heterogeneity was high, partly explained by baseline stroke severity and study size. Overall risk of bias was low to moderate. Conclusions: Standard-dose thrombolysis within 4.5 hours in LMICs shows efficacy and safety comparable to reports from high-income countries, with regional variation in safety and mortality. These results support broader implementation of thrombolysis in resource-limited settings to reduce global stroke disparities.

Instituciones: Universidad Peruana Cayetano Heredia; Universidad Científica del Sur; Universidad Nacional Pedro Ruiz Gallo