Objectives. Unknown onset stroke (UOS) is usually excluded from intravenous thrombolysis concerning the unclear symptom onset time. Attempts have been done to use thrombolytic therapy in these patients. The current meta-analysis was done to examine the efficacy and safety of intravenous thrombolysis in UOS. Methods. PubMed, Web of Science, and Cochrane Library were searched for studies comparing thrombolysis with conservative therapy among UOSs. Data of good outcome (mRS, 0-2), mortality, and intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) were extracted and analyzed using the Revman 5.2 software. Results. In total, 8 studies with 1271 subjects (542 with thrombolysis and 729 with conservative therapy) were included in this meta-analysis. The data showed that patients receiving thrombolysis had a higher incidence of 90-day good outcome () than conservative therapy. The comparison of discharge () and 90-day mortality () in both groups did not find any significances. The incidences of ICH () and sICH () were relatively comparable between the two therapies. Conclusions. Intravenous thrombolysis is a better choice for UOS patients for its efficacy and safety. In addition, pretreatment imaging assessment is beneficial for improving the efficacy of thrombolytic therapy. However, it needs more supporting evidences for clinical use in the future.

中文翻译：

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未知卒中患者静脉溶栓的疗效和安全性：荟萃分析。

目标。由于症状发作时间不明确，通常将不明发作中风（UOS）排除在静脉溶栓之外。已经尝试在这些患者中使用溶栓疗法。目前的荟萃分析旨在检查 UOS 中静脉溶栓的有效性和安全性。方法。在 PubMed、Web of Science 和 Cochrane Library 中搜索了比较 UOS 中溶栓与保守治疗的研究。使用 Revman 5.2 软件提取和分析良好结果 (mRS, 0-2)、死亡率、脑出血 (ICH) 和症状性 ICH (sICH) 的数据。结果. 该荟萃分析共纳入 8 项研究，涉及 1271 名受试者（542 名溶栓治疗和 729 名保守治疗）。数据显示，接受溶栓治疗的患者90天良好结局的发生率更高（)比保守治疗。放电比较（)和 90 天死亡率 ()在两组中都没有发现任何意义。ICH的发生率（)和 sICH ()在两种疗法之间具有相对可比性。结论。静脉溶栓因其疗效和安全性而成为UOS患者较好的选择。此外，治疗前影像学评估有利于提高溶栓治疗的疗效。然而，它需要更多的支持证据用于未来的临床应用。