Outcomes of Intra-Arterial Urokinase After Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism: A Secondary Analysis of the POST-UK Trial
In brief
Urokinase raised 90-day disability-free survival by 49% after stroke reperfusion
In a secondary analysis of 209 patients with cardioembolic stroke who had near-complete or complete reperfusion, adding urokinase was linked to a 49% higher chance of being disability-free at 90 days. Death and brain bleeding rates did not differ significantly between groups. The findings apply to this selected patient group; larger studies are needed to confirm the benefit.
- Journal
- Journal of the American Heart Association (Q1)
- Published
- 23 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jiaxing Song, Xuexiao Zhao, Gaoming Li, Mingrui Zhou, Lingyu Zhang, Haoxuan Zhu, et al.
- PMID
- 42924849
- DOI
- 10.1161/JAHA.126.052937
Why clinicians should know about it
- Picked for Neurology (clinical) (top studies of the week, 8 November 2026): Randomized-trial subgroup evaluates adjunctive stroke thrombolysis
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.