Effects of intravenous rtPA in patients with minor stroke

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.

KEY MESSAGES

• 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.

Keywords:

• Thrombolytic therapy
• minor stroke
• propensity Score-Matched
• outcome

Acknowledgments

We thank all the patients, study investigators, and staff involved in this study.

Author contributions statement

ZH Lei, LJ Ren, and SY Pan conceived of and designed the study. XH Wu, HY Feng, SY Hu, SL Li, and J Li performed data collection. ZH Lei, HY Feng, and SL Li performed statistical analyses and drafted the manuscript. SY Pan and GL Xu reviewed and edited the manuscript. All authors have read and approved the manuscript.

Ethical statement

This study was performed in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Shenzhen Cerebrovascular Disease Treatment and Quality Control Center. Because retrospective analyses were performed using fully anonymized data in the present study, the requirement for informed consent was waived.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data analyzed in the current study are available from the corresponding author upon reasonable request.

Additional information

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).