Intravenous thrombolysis in Chinese patients with mild acute ischemic stroke

Yunyun Xiong; Ran Yan; Hongqiu Gu; Shang Wang; Marc Fisher; Xingquan Zhao; Xin Yang; Chunjuan Wang; Zhou Qi; Xia Meng; Zixiao Li; Yongjun Wang

doi:10.21037/atm-21-40

Intravenous thrombolysis in Chinese patients with mild acute ischemic stroke

Ann Transl Med. 2021 May;9(9):767. doi: 10.21037/atm-21-40.

Authors

Yunyun Xiong^{1

2}, Ran Yan², Hongqiu Gu^{2

3}, Shang Wang⁴, Marc Fisher⁵, Xingquan Zhao^{1

2}, Xin Yang^{1

3}, Chunjuan Wang^{1

3}, Zhou Qi², Xia Meng², Zixiao Li^{1

2

3

6}, Yongjun Wang^{1

2

3

6}

Affiliations

¹ Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ National Center for Healthcare Quality Management in Neurological Diseases, Beijing, China.
⁴ Neurocardiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁶ Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China.

Abstract

Background: Mild stroke accounts for more than a half of all stroke patients, and short-term outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) have not been fully investigated in this group.

Methods: Our study investigated short-term outcomes and predictors for a favorable functional outcome at discharge in mild stroke patients with IV rtPA. 6,752 mild stroke patients in the China Stroke Center Alliance with a clinical diagnosis of acute ischemic stroke, within 4.5 hours from symptom onset, with a baseline National Institutes of Health Stroke Scale score ≤5 and received rt-PA treatment were included in this retrospective analysis. Univariable and multivariable analyses were performed to identify factors independently associated with a favorable functional outcome.

Results: Only 18.5% had an unfavorable functional outcome at discharge, 91.1% were discharged home, 89.9% could ambulate independently, 95.9% had a length of stay of 3 days or longer and 1.9% had sICH. A multivariable Logistic regression model identified that age >80 years [adjusted odds ratio (aOR): 1.57 (1.1-2.25)], diabetes mellitus [aOR: 1.35 (1.16-1.58)], 3-4.5 h time window [aOR: 1.43 (1.26-1.63)] and NIHSS score [3 vs. 0, aOR: 1.49 (1.05-2.11); 4 vs. 0, aOR: 2.36 (1.68-3.33); 5 vs. 0, aOR: 2.51 (1.77-3.56)] were independent risk factors for mRS >2 with hospital region, hospital level and hypertension as covariates.

Conclusions: Our findings suggest that tPA is safe and effective in mild stroke patients with age ≤80 within the 3 hour time window and in those without diabetes mellitus, further studies are needed to confirm the findings.

Keywords: NIHSS; Thrombolysis; outcome; recombinant tissue plasminogen activator antigen (rtPA); stroke, ischemic.