The use of alteplase, although safe, does not offer clear clinical advantages when mild stroke is non-disabling

Giovanni Merlino; Lorenzo Nesi; Pietro Vergobbi; Marco Domenico Scanni; Sara Pez; Alessandro Marziali; Yan Tereshko; Giuseppe Sportelli; Simone Lorenzut; Francesco Janes; Gian Luigi Gigli; Mariarosaria Valente

doi:10.3389/fneur.2023.1212712

The use of alteplase, although safe, does not offer clear clinical advantages when mild stroke is non-disabling

Front Neurol. 2023 Jul 17:14:1212712. doi: 10.3389/fneur.2023.1212712. eCollection 2023.

Authors

Affiliations

¹ Stroke Unit, Department of Head-Neck and Neuroscience, Udine University Hospital, Udine, Italy.
² Clinical Neurology, Udine University Hospital, Udine, Italy.
³ Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy.

^# Contributed equally.

Abstract

Introduction: It is unknown whether alteplase is effective and safe in patients with mild acute ischemic stroke (AIS). Determining whether symptoms are "disabling" or not is a crucial factor in the management of these patients. This study aimed to investigate the efficacy and safety of alteplase in patients with mild, non-disabling AIS.

Methods: We included all consecutive patients admitted for AIS at our institution from January 2015 to May 2022 who presented a baseline NIHSS score of 0-5 and fit the criteria to receive intravenous thrombolysis. In order to select only subjects with non-disabling AIS, we excluded patients who scored more than 1 point in the following NIHSS single items: vision, language, neglect, and single limb. Patients who scored at least 1 point in the NIHSS consciousness item were excluded as well. This study is a retrospective analysis of a prospectively collected database.

Results: After the application of the exclusion criteria, we included 319 patients, stratified into patients receiving and not receiving alteplase based on non-disabling symptoms. The two groups were comparable regarding demographic and clinical data. Rates of a 3-month favorable outcome, defined as a 3-month mRS score of 0-1, were similar, being 82.3% and 86.1% in the treated and untreated patients, respectively. Hemorrhagic complications and mortality occurred infrequently and were not affected by alteplase treatment.

Discussion: This observational study suggests that the use of alteplase, although safe, is not associated with a better outcome in highly selected patients with non-disabling AIS.

Keywords: NIHSS; alteplase; intravenous thrombolysis; mild stroke; non-disabling stroke.