Uric acid therapy improves the outcomes of stroke patients treated with intravenous tissue plasminogen activator and mechanical thrombectomy.
Level 2 - randomized trial
Subgroup analysis of an individual randomized controlled trial
PubMed 28345429 · doi:10.1177/1747493016684354
What was done
In a subgroup analysis of the URICO-ICTUS randomized controlled trial (NCT00860366), 45 patients with acute ischemic stroke and proximal vessel occlusions received intravenous recombinant tissue plasminogen activator within 4.5 hours of onset and were randomized to receive 1000 mg intravenous uric acid (n = 24) or placebo (n = 21). All included patients subsequently underwent mechanical thrombectomy after CT angiography confirmed lack of proximal recanalization post-thrombolysis. The primary outcome was good functional outcome at 90 days (modified Rankin Scale 0–2). Safety endpoints included mortality, symptomatic intracerebral hemorrhage, and gout attacks.
What was found
Successful revascularization exceeded 80% in both arms. Good functional outcome at 90 days occurred in 16 of 24 (67%) patients treated with uric acid versus 10 of 21 (48%) treated with placebo (adjusted OR 6.12, 95% CI 1.08–34.56). Mortality occurred in 2 of 24 (8.3%) patients in the uric acid group and 1 of 21 (4.8%) in the placebo group (adjusted OR 3.74, 95% CI 0.06–226.29). Symptomatic intracerebral hemorrhage and gout attack rates were reported as similar between groups, though exact numbers were not reported in the abstract.
Why it matters
Antioxidant therapy with uric acid may provide neuroprotective benefit when paired with mechanical recanalization in acute ischemic stroke, an area where neuroprotective agents have consistently failed.
Limits
The sample size is very small (n = 45), producing extremely wide confidence intervals for both efficacy and safety estimates. As a subgroup analysis from a broader trial, it was not independently powered, and exact counts for bleeding events and gout attacks were omitted from the abstract.
Cited by
- supports Clinical studies in Spain have investigated intravenous uric acid infusion acutely in stroke patients and suggested potential acute benefits.