---
type: "example"
title: "Evidence Example: evidence-example-stroke-0-3-alteplase-vs-no-alteplase-mRS3-6"
resource: "Evidence"
example: "evidence-example-stroke-0-3-alteplase-vs-no-alteplase-mRS3-6"
---
# Evidence Example: evidence-example-stroke-0-3-alteplase-vs-no-alteplase-mRS3-6

## Narrative

"Effect of Alteplase vs No alteplase on mRS 3-6 at 90 days in Stroke 0-3 hours prior" is a comparative effect estimate.

## Example XML



```xml
<?xml version="1.0" encoding="UTF-8"?>

<Evidence xmlns="http://hl7.org/fhir">
  <id value="example-stroke-0-3-alteplase-vs-no-alteplase-mRS3-6"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
      
      <p>
        &quot;Effect of Alteplase vs No alteplase on mRS 3-6 at 90 days in Stroke 0-3 hours prior&quot; is a comparative effect estimate.
      </p>
	
    </div>
  </text>
  <url value="http://hl7.org/fhir/Evidence/example-stroke-0-3-alteplase-vs-no-alteplase-mRS3-6"/>
  <identifier>
    <system value="urn:ietf:rfc:3986"/>
    <value value="urn:oid:2.16.840.1.113883.4.642.10.5"/>
  </identifier>
  <name value="EffectOfAlteplaseVsNoAlteplaseOnMRS36At90DaysInStroke03HoursPrior"/>
  <title value="Effect of Alteplase vs No alteplase on mRS 3-6 at 90 days in Stroke 0-3 hours prior"/>
  <status value="draft"/>
  <relatesTo>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/artifact-relationship-type" />
        <code value="cites" />
        <display value="Cites" />
      </coding>
    </type>
    <targetMarkdown value="Analysis 1.16 from Wardlaw 2014 &lt;b&gt;Citation:&lt;/b&gt; Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2014 Jul 29(7):CD000213. PMID 25072528 &lt;b&gt;URL:&lt;/b&gt; https://doi.org/10.1002/14651858.CD000213.pub3"/>
  </relatesTo>
  <description value="mRS 3-6 at 90 days Odds Ratio 0.65 for Alteplase vs. No Alteplase in patients with acute ischemic stroke 0-3 hours prior"/>
  <variableDefinition>
    <variableRole value="population"/>
    <observed>
      <reference value="EvidenceVariable/Wardlaw2014Analysis1.16.3EvidenceSet"/>
      <type value="EvidenceVariable"/>
      <display value="Wardlaw 2014 Analysis 1.16.3 Evidence set"/>
    </observed>
    <intended>
      <reference value="Group/AcuteIschemicStroke0-3Hours"/>
      <type value="Group"/>
      <display value="stroke at 0-3 hours"/>
    </intended>
  </variableDefinition>
  <variableDefinition>
    <variableRole value="outcome"/>
    <observed>
      <reference value="EvidenceVariable/example-mRS3-6-at-90days"/>
      <type value="EvidenceVariable"/>
      <display value="mRS 3-6 at 90 days"/>
    </observed>
    <intended>
      <reference value="EvidenceVariable/example-dead-or-dependent-90day"/>
      <type value="EvidenceVariable"/>
      <display value="Dead or functionally dependent at 90 days"/>
    </intended>
  </variableDefinition>
  <variableDefinition>
    <variableRole value="exposure"/>
    <comparatorCategory value="No Alteplase"/>
    <observed>
      <reference value="EvidenceVariable/example-group-assignment-alteplase-for-stroke-vs-no-alteplase"/>
      <type value="EvidenceVariable"/>
      <display value="Group Assignment: Alteplase for Stroke vs No Alteplase"/>
    </observed>
  </variableDefinition>
  <synthesisType>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/synthesis-type"/>
      <code value="std-MA"/>
      <display value="summary data meta-analysis"/>
    </coding>
  </synthesisType>
  <studyDesign>
    <coding>
      <system value="https://fevir.net/sevco"/>
      <code value="SEVCO:01003"/>
      <display value="randomized assignment"/>
    </coding>
  </studyDesign>
  <statistic>
    <statisticType>
      <coding>
        <system value="https://fevir.net/sevco"/>
        <code value="STATO:0000182"/>
        <display value="odds ratio"/>
      </coding>
    </statisticType>
    <quantity>
      <value value="0.65"/>
    </quantity>
    <numberOfEvents value="1137"/>
    <sampleSize>
      <numberOfStudies value="6"/>
      <numberOfParticipants value="1779"/>
    </sampleSize>
    <attributeEstimate>
      <description value="95% CI 0.54 to 0.80"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/attribute-estimate-type"/>
          <code value="C53324"/>
          <display value="Confidence interval"/>
        </coding>
      </type>
      <level value="0.95"/>
      <range>
        <low>
          <value value="0.54"/>
        </low>
        <high>
          <value value="0.8"/>
        </high>
      </range>
    </attributeEstimate>
    <attributeEstimate>
      <description value="P-value = 0.000023"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/attribute-estimate-type"/>
          <code value="C44185"/>
          <display value="P-value"/>
        </coding>
      </type>
      <quantity>
        <value value="0.000023"/>
      </quantity>
    </attributeEstimate>
    <attributeEstimate>
      <description value="Heterogeneity I-sq = 0.0%"/>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/attribute-estimate-type"/>
          <code value="0000420"/>
          <display value="I-squared"/>
        </coding>
      </type>
      <quantity>
        <value value="0"/>
        <unit value="%"/>
        <system value="http://unitsofmeasure.org"/>
        <code value="%"/>
      </quantity>
    </attributeEstimate>
  </statistic>
  <certainty>
    <description value="Moderate certainty due to risk of bias"/>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
        <code value="Overall"/>
        <display value="Overall certainty"/>
      </coding>
    </type>
    <rating>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/>
        <code value="moderate"/>
        <display value="Moderate quality"/>
      </coding>
    </rating>
    <subcomponent>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
          <code value="PublicationBias"/>
          <display value="Publication bias"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/>
          <code value="no-concern"/>
          <display value="no serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
          <code value="Inconsistency"/>
          <display value="Inconsistency"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/>
          <code value="no-concern"/>
          <display value="no serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
          <code value="Imprecision"/>
          <display value="Imprecision"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/>
          <code value="no-concern"/>
          <display value="no serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
          <code value="Indirectness"/>
          <display value="Indirectness"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/>
          <code value="no-concern"/>
          <display value="no serious concern"/>
        </coding>
      </rating>
    </subcomponent>
    <subcomponent>
      <note>
        <text value="results largely influenced by IST-3 trial which was unblinded and NINDS trial which had allocation concealment not stated and baseline imbalances"/>
      </note>
      <type>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-type"/>
          <code value="RiskOfBias"/>
          <display value="Risk of bias"/>
        </coding>
      </type>
      <rating>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/certainty-rating"/>
          <code value="serious-concern"/>
          <display value="serious concern"/>
        </coding>
      </rating>
    </subcomponent>
  </certainty>
</Evidence>
```