POST-UK
Trial question
What is the role of adjunctive intra-arterial urokinase after endovascular reperfusion in patients with AIS?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 532
532 patients (223 female, 309 male).
Inclusion criteria: patients with AIS due to large vessel occlusion who achieved near-complete to complete reperfusion by endovascular thrombectomy.
Key exclusion criteria: ICH; treatment with intravenous thrombolysis; prestroke mRS score ≥ 2; systolic pressure > 185 mmHg or diastolic pressure > 110 mmHg; bleeding in the last 1 month; chronic hemodialysis and severe renal insufficiency; terminal illness with a life expectancy < 6 months; pregnancy or lactation.
Interventions
N=266 intra-arterial urokinase (receipt of endovascular treatment plus a single dose of 100,000 IU dose of intra-arterial urokinase for 10-15 minutes).
N=266 standard treatment (receipt of endovascular treatment without intra-arterial thrombolysis).
Primary outcome
Survival without disability at day 90
45.1%
40.2%
45.1 %
33.8 %
22.6 %
11.3 %
0.0 %
Intra-arterial
urokinase
Standard
treatment
No significant
difference ↔
No significant difference in survival without disability at day 90 (45.1% vs. 40.2%; RR 1.13, 95% CI 0.94 to 1.36).
Secondary outcomes
No significant difference in mRS score of 0-2 at day 90 (53.8% vs. 52.3%; RR 1.04, 95% CI 0.89 to 1.2).
No significant difference in improvement in NIHSS score at 5-7 days or discharge if earlier (52.3% vs. 43.7%; WR 1.17, 95% CI 0.95 to 1.45).
No significant difference in European QoL Five-Dimension Five-Level score at day 90 (43.7% vs. 39.4%; WR 1.11, 95% CI 0.88 to 1.4).
Safety outcomes
No significant differences in death within day 90, symptomatic ICH within 48 hours.
Conclusion
In patients with AIS due to large vessel occlusion who achieved near-complete to complete reperfusion by endovascular thrombectomy, intra-arterial urokinase was not superior to standard treatment with respect to survival without disability at day 90.
Reference
Chang Liu, Changwei Guo, Fengli Li et al. Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke: The POST-UK Randomized Clinical Trial. JAMA. 2025 Feb 18;333(7):589-598.
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