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Adjunctive intra-arterial urokinase increases odds of disability-free survival by 1.49 in cardioembolic strokeTrial shows urokinase improves survival for certain stroke patients

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Key Takeaway
Consider adjunctive intra-arterial urokinase to improve 90-day disability-free survival in cardioembolic stroke.

This randomized controlled trial secondary analysis included 209 patients with acute ischemic stroke due to cardioembolism who achieved near-complete to complete reperfusion. The study evaluated the impact of adjunctive intra-arterial urokinase compared to a control group on functional outcomes at 90 days.

The primary outcome was disability-free survival at 90 days (modified Rankin Scale score of 0 to 1). Patients receiving adjunctive intra-arterial urokinase showed an increased odds of disability-free survival (adjusted risk ratio, 1.49; 95% CI, 1.08-2.06; p=0.01). When using inverse probability of treatment weighting, the adjusted risk ratio was 1.47 (95% CI, 1.04-2.09; p=0.03).

Safety assessments showed no significant differences between the intervention and control groups regarding 90-day all-cause death, symptomatic intracranial hemorrhage, or any intracranial hemorrhage within 48 hours. The study suggests that adjunctive intra-arterial urokinase may improve functional outcomes in this specific subset of cardioembolic stroke patients without increasing major safety risks. However, as a secondary analysis of the POST-UK trial, results should be interpreted within that context.

How this fits prior evidence

How this fits prior evidence: This finding extends the clinical understanding of urokinase in acute ischemic stroke. While a prior Phase I trial assessed intravenous urokinase dosing but lacked efficacy data and safety results for clinical decision-making, this randomized controlled trial provides specific efficacy data for intra-arterial administration in patients with achieved reperfusion. It does not directly relate to the findings regarding Tenecteplase and Alteplase combined with EVT for large vessel occlusion.

When a person suffers a stroke caused by a blood clot from the heart, every moment counts. Doctors are always looking for ways to help patients regain their independence and live without lasting disabilities. This study looked at a specific group of patients who had already received successful treatment to clear their blocked arteries.

Researchers looked at 209 patients and found that adding a medication called urokinase into the artery helped. This treatment increased the odds of patients living without significant disabilities after 90 days. The study specifically looked at those who had a cardioembolism, which is a stroke caused by a clot traveling from the heart.

Importantly, the study found that this extra step did not increase the risk of death or cause dangerous bleeding in the brain. While this is a secondary analysis of a larger trial, it offers a clearer look at how this specific medication can help patients recover their mobility and quality of life.

What this means for you:
Adding urokinase can improve the chances of a good recovery for certain types of heart-related strokes.

Common questions

What is urokinase and how does it help?

Urokinase is a medication that can be delivered directly into an artery. In this study, it was used as an extra step for patients who already had their blocked arteries opened. The results showed it increased the odds of patients living without disabilities after 90 days.

Is it safe to use this treatment for stroke patients?

The study found no significant differences in safety between the groups. Patients who received the extra urokinase did not have higher rates of death or brain bleeding within 48 hours compared to those who did not receive it.

Who specifically does this finding help?

This finding specifically helps patients who have an acute ischemic stroke caused by cardioembolism. These are patients who have already achieved near-complete or complete opening of their blocked arteries during initial treatment.

Study Details

Study typeRct
Sample sizen = 209
EvidenceLevel 2
PublishedNov 2026
View Original 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]; =0.01; inverse probability of treatment weighting adjusted risk ratio, 1.47 [95% CI, 1.04-2.09]; =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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