Outcomes of Intra‐Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism: A Secondary Analysis of the POST‐UK Trial
5 affiliations
- 1The Second Affiliated Hospital of Chongqing Medical University
- 2Army Medical University (Third Military Medical University)
- 3Hubei University of Chinese Medicine
- 4Lanzhou University Second Hospital
- 5The 908th Hospital of Chinese People's Liberation Army Joint Logistic Support Force
Abstract
Background Whether adjunctive intra‐arterial thrombolysis improves outcomes in patients with acute ischemic stroke due to cardioembolism remains unclear. This study aimed to investigate the efficacy and safety of adjunctive intra‐arterial urokinase in patients with acute ischemic stroke due to cardioembolism who achieved near‐complete to complete reperfusion. Methods This study was a secondary analysis of the POST‐UK (Adjunctive Intra‐Arterial Urokinase After Near‐Complete to Complete Reperfusion for Acute Ischemic Stroke) trial, which was conducted from November 15, 2022, to March 29, 2024. Patients were randomly assigned to the intra‐arterial urokinase group or the control group. The primary outcome was disability‐free survival at 90 days, defined as a modified Rankin Scale score of 0 to 1. Safety outcomes included 90‐day all‐cause death, symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. Results Among 209 patients with cardioembolism (median age 73 [interquartile range, 63–81] years; 45.9% men), 106 were assigned to the control group and 103 to the intra‐arterial urokinase group. Compared with the control group, adjunctive intra‐arterial urokinase significantly increased the odds of disability‐free survival at 90 days (adjusted risk ratio, 1.49 [95% CI, 1.08–2.06]; P =0.01; inverse probability of treatment weighting adjusted risk ratio, 1.47 [95% CI, 1.04–2.09]; P =0.03). No significant differences were found between groups in 90‐day mortality rate, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours. Conclusions In patients with acute ischemic stroke due to cardioembolism who achieved near‐complete to complete reperfusion, adjunctive intra‐arterial urokinase significantly improved disability‐free survival at 90 days without increasing the risk of death or intracranial hemorrhage. Registration URL: ChiCTR.org.cn; Unique identifier: ChiCTR2200065617.
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BibTeX
@article{song2026outcomes,
title = {{Outcomes of Intra‐Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism: A Secondary Analysis of the POST‐UK Trial}},
author = {Jiaxing Song and Xuexiao Zhao and Gaoming Li and Mingrui Zhou and Lingyu Zhang and Haoxuan Zhu and Guanting Heng and Xu Xu and Jinfu Ma and Zhixi Wang and Jiayu Li and Qiuyi Yang and Yian Chen and Mingyang Chen and Yihui Yang and Yuhan Fan and Kaiyuan Feng and Chunye Chen and Miao Chai and Wenjie Zi},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.052937},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.052937},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Outcomes of Intra‐Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism: A Secondary Analysis of the POST‐UK Trial
AU - Jiaxing Song
AU - Xuexiao Zhao
AU - Gaoming Li
AU - Mingrui Zhou
AU - Lingyu Zhang
AU - Haoxuan Zhu
AU - Guanting Heng
AU - Xu Xu
AU - Jinfu Ma
AU - Zhixi Wang
AU - Jiayu Li
AU - Qiuyi Yang
AU - Yian Chen
AU - Mingyang Chen
AU - Yihui Yang
AU - Yuhan Fan
AU - Kaiyuan Feng
AU - Chunye Chen
AU - Miao Chai
AU - Wenjie Zi
PY - 2026
DA - 2026/10/23
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.052937
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.052937
AB - Background Whether adjunctive intra‐arterial thrombolysis improves outcomes in patients with acute ischemic stroke due to cardioembolism remains unclear. This study aimed to investigate the efficacy and safety of adjunctive intra‐arterial urokinase in patients with acute ischemic stroke due to cardioembolism who achieved near‐complete to complete reperfusion. Methods This study was a secondary analysis of the POST‐UK (Adjunctive Intra‐Arterial Urokinase After Near‐Complete to Complete Reperfusion for Acute Ischemic Stroke) trial, which was conducted from November 15, 2022, to March 29, 2024. Patients were randomly assigned to the intra‐arterial urokinase group or the control group. The primary outcome was disability‐free survival at 90 days, defined as a modified Rankin Scale score of 0 to 1. Safety outcomes included 90‐day all‐cause death, symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. Results Among 209 patients with cardioembolism (median age 73 [interquartile range, 63–81] years; 45.9% men), 106 were assigned to the control group and 103 to the intra‐arterial urokinase group. Compared with the control group, adjunctive intra‐arterial urokinase significantly increased the odds of disability‐free survival at 90 days (adjusted risk ratio, 1.49 [95% CI, 1.08–2.06]; P =0.01; inverse probability of treatment weighting adjusted risk ratio, 1.47 [95% CI, 1.04–2.09]; P =0.03). No significant differences were found between groups in 90‐day mortality rate, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours. Conclusions In patients with acute ischemic stroke due to cardioembolism who achieved near‐complete to complete reperfusion, adjunctive intra‐arterial urokinase significantly improved disability‐free survival at 90 days without increasing the risk of death or intracranial hemorrhage. Registration URL: ChiCTR.org.cn; Unique identifier: ChiCTR2200065617.
SN - 2047-9980
ER -