Title:Erythropoietin Treatment in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Volume: 14
Issue: 6
Author(s): Xiyang Yao, Dapeng Wang, Haiying Li, Haitao Shen, Zhang Shu*Gang Chen*
Affiliation:
- Department of Neurosurgery, Taicang First People’s Hospital, Taicang, 215400,China
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006,China
Keywords:
Acute ischemic stroke, erythropoietin, meta-analysis, randomized controlled trials, recombinant tissue plasminogen
activator, systematic review.
Abstract: Objective: Erythropoietin (EPO) for treating acute ischemic stroke (AIS) has been investigated
in many studies. However, the evidence was inconsistent. Thus, a systematic review and metaanalysis
were performed to elucidate the role of EPO in treating patients with AIS.
Methods: Two electronic databases (PubMed and EMBASE) were used. 30-day NIHSS measures primary
outcome while all-cause mortality in the follow up and 90-day Barthel Index were regarded as
secondary outcome. Results are presented as relative risk (RR), standardized mean difference (SMD)
and 95% confidence intervals (CI). We employed Stata software to perform the meta-analysis.
Results: Four randomized controlled trials (RCTs) involving 784 patients were contained in this metaanalysis.
The total combined results on 30-day NIHSS were (SMD = -0.52, 95% CI: -1.39, 0.34) with
random-effects model and sensitivity analysis showed a significant difference after excluding the
Ehrenreich 2009 trial. The total combined secondary measured results were (RR=1.72, 95% CI: 1.10,
2.70) and (SMD = 0.01, 95% CI: -0.14, 0.16) for all-cause mortality and 90-day Barthel Index. In the
subgroup analysis by using recombinant tissue plasminogen activator (rtPA) earlier, the rtPA group showed
increased all-cause mortality with the result of (RR = 1.92, 95% CI: 1.04, 3.52), but not in non-rtPA group.
Conclusion: To our systematic review and meta-analysis, we didn’t recommend EPO administration
for patients with AIS, especially with the combination of rtPA. Large RCTs are warranted to examine
EPO efficacy in AIS patients in the future.
