Effects of intravenous rtPA in patients with minor stroke

Zhihao Lei; Shuanglin Li; Hongye Feng; Xiaohong Wu; Shiyu Hu; Jun Li; Gelin Xu; Lijie Ren; Suyue Pan

doi:10.1080/07853890.2024.2304653

Effects of intravenous rtPA in patients with minor stroke

Ann Med. 2024 Dec;56(1):2304653. doi: 10.1080/07853890.2024.2304653. Epub 2024 Jan 30.

Authors

Zhihao Lei^{1

2

3}, Shuanglin Li⁴, Hongye Feng^{2

3}, Xiaohong Wu^{2

3}, Shiyu Hu^{2

3}, Jun Li^{2

3}, Gelin Xu^{2

3}, Lijie Ren^{2

3}, Suyue Pan¹

Affiliations

¹ Department of Neurology, Nanfang Hospital, Southern Medical University/The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
² Department of Neurology, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China.
³ Shenzhen Cerebrovascular Disease Treatment and Quality Control Center, Shenzhen, China.
⁴ Department of Anatomy and Histology, School of Basic Medical Sciences, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China.

Abstract

Background: Whether minor ischemic stroke (MIS) patients can benefit from intravenous thrombolysis (IVT) remains controversial. The association between the efficacy of IVT and baseline National Institute of Health Stroke Scale (NIHSS) score is unclear in MIS, while the association in moderate and severe stroke is known. This study aimed to explore the effect of IVT in patients with MIS and analyze its efficacy in patients with different baseline NIHSS scores.

Methods: Patients with a NIHSS score ≤5 within 4.5 h of stroke onset were screened in 32 centers. Patients with and without IVT were matched to a ratio of 1:1 with propensity scores. An excellent outcome was defined as a modified Rankin Scale (mRS) score ≤1 at three months after stroke onset. Safety outcomes included mortality and symptomatic intracranial hemorrhage (sICH). Multivariate analysis was used to compute the adjusted odds ratio (OR) for excellent outcomes. The effect of IVT was further analyzed in subgroups according to the baseline NIHSS score.

Results: Of the 23,853 screened, 3336 patients with MIS who arrived at the hospital within 4.5 h of onset were included. The 1163 patients treated with IVT were matched with 1163 patients without IVT. IVT in minor strokes generated an adjusted OR of 1.38 (95% CI: 1.09-1.75, p = 0.009) for excellent outcomes. There were no significant differences in mortality (0.17% vs. 0.09%, p = 1.000) and sICH (0.69% vs. 0.86%, p = 0.813) between patients with and without IVT. Subgroup analysis showed that there was no significant effect of IVT in the baseline NIHSS 0-1 or 2-3 subgroups, with adjusted OR of 0.816 (95% CI 0.437-1.53, p = 0.525) and1.22 (95% CI 0.845-1.77, p = 0.287), respectively. In patients with NIHSS score of 4-5, IVT was significantly effective, with an adjusted OR of 1.53 (95% CI 1.02-2.30, p = 0.038).

Conclusion: IVT can improve MIS outcomes. The risks of sICH and mortality did not increase, especially in patients with NIHSS scores 4 to 5, who could benefit from IVT significantly.

Keywords: Thrombolytic therapy; minor stroke; outcome; propensity Score-Matched.

Plain language summary

Overall, intravenous thrombolysis can improve the outcomes of patients with minor stroke.Minor stroke patients with a baseline NIHSS score of 4-5 can benefit the most from intravenous thrombolysis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / drug therapy
Brain Ischemia* / etiology
Fibrinolytic Agents / adverse effects
Humans
Ischemic Stroke* / drug therapy
Stroke* / etiology
Thrombolytic Therapy / adverse effects
Treatment Outcome

Substances

Fibrinolytic Agents

Grants and funding

This study was supported by Scientific Research Items of Shenzhen Science and Technology Innovation Committee (No. GJHZ20200731095602009), Guangdong Provincial Medical Science and Technology Research Fund Project (No. A2022185), Science and Technology Innovation Commission of Shenzhen (ZDSYS20200811142600003), and Research start-up fund of Shenzhen University (000001032013/868).