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Thromb Haemost 2023; 123(07): 734-743
DOI: 10.1055/s-0043-1768150
Stroke, Systemic or Venous Thromboembolism

Intravenous Thrombolysis or Medical Management for Minor Strokes

Wen-Jun Tu
1   Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, People's Republic of China
2   Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
,
Yicheng Xu
3   Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
,
Yakun Liu
4   Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
,
Jilai Li
3   Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
,
Jichen Du
3   Department of Neurology, Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, Beijing, People's Republic of China
,
Jizong Zhao
2   Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
› Institutsangaben Funding This study was supported by grants from China Postdoctoral Science Foundation (No. 2019M660921 and 2020T130436). The funding organizations had no role in the study's design and concept; the collection, management, analysis, and interpretation of the data; or the manuscript's preparation, review, or approval.
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Abstract

Objective To evaluate the outcomes of acute ischemic stroke patients with minor deficits treated with either intravenous thrombolysis (IVT) or routine medical management (MM).

Methods The study included patients with acute ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) scores of 5 or less who were treated with IVT within 4.5 hours from symptom onset and were classified as the IVT group. The MM group consisted of an equal number of patients with minor strokes, matched for sex, age, and severity, who did not receive thrombolysis. Data on patient information were collected for both groups.

Results A total of 26,236 patients were included in this study (13,208 in IVT and 13,208 in MM). Of these patients, 67.9% were men, and the mean age was 67.1 years (standard deviation: 10.9). At 3 months, the IVT group had a higher rate of stroke-independent outcome (Rankin Scale score of 0–2) compared with the MM group (IVT vs. MM: 91.6 vs. 88.6%, absolute difference: 2.5%, 95% confidence interval [CI]: 1.6–3.4%, p = 0.008; adjusted hazard ratio [HR]: 1.2, 95% CI: 1.1–1.4, p = 0.003). Furthermore, there was no significant difference in 3-month mortality rates between the IVT and MM groups (IVT vs. MM: 2.1 vs. 2.5%, absolute difference: −0.6%, 95% CI: −1.1 to 0.3%, p = 0.11; adjusted HR: 0.9, 95% CI: 0.8–1.2, p = 0.09).

Conclusion Compared with MM, IVT does not reduce mortality in minor ischemic stroke but improves functional outcomes in minor stroke with an NIHSS score of 3 to 5.

Keywords

ischemic stroke - minor - intravenous thrombolysis - medical management

Data Availability Statement

Please contact the corresponding author (Prof. Tu) for the data request.


Ethical Approval Statement

This study was approved by the Ethics Committee of Aerospace Center Hospital and Peking University Aerospace School of Clinical Medicine, with a waiver of informed consent.


Authors' Contribution

Drs Tu and Zhao contributed equally to this work. They had full access to all the data in the study and took responsibility for the integrity of the data and the data analysis accuracy. Study concept and design: all authors; acquisition of data: Tu, Xu, and Liu; analysis and interpretation of data: Tu, Xu, and Liu; drafting of the manuscript: Tu, Xu, Liu, and Li; critical revision of the manuscript for important intellectual content: Li, Du, and Zhao; statistical analysis: Tu, Xu, and Li; administrative, technical, or material support: all authors; obtained funding: Tu; study supervision: Zhao.




Publikationsverlauf

Eingereicht: 11. September 2022

Angenommen: 09. März 2023

Artikel online veröffentlicht:
10. April 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Tu WJ, Hua Y, Yan F. et al. Prevalence of stroke in China, 2013-2019: a population-based study. Lancet Reg Health West Pac 2022; 28: 100550
    CrossrefPubMedSuche in Google Scholar
  • 2 Seners P, Ben Hassen W, Lapergue B. et al; MINOR-STROKE Collaborators. Prediction of early neurological deterioration in individuals with minor stroke and large vessel occlusion intended for intravenous thrombolysis alone. JAMA Neurol 2021; 78 (03) 321-328
    CrossrefPubMedSuche in Google Scholar
  • 3 Tu WJ, Zhao Z, Yin P. et al. Estimated burden of stroke in China in 2020. JAMA Netw Open 2023; 6 (03) e231455
    CrossrefPubMedSuche in Google Scholar
  • 4 Khatri P, Conaway MR, Johnston KC. Acute Stroke Accurate Prediction Study (ASAP) Investigators. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke. Stroke 2012; 43 (02) 560-562
    CrossrefPubMedSuche in Google Scholar
  • 5 Messé SR, Khatri P, Reeves MJ. et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology 2016; 87 (15) 1565-1574
    CrossrefPubMedSuche in Google Scholar
  • 6 Asdaghi N, Wang K, Ciliberti-Vargas MA. et al; FL-PR CReSD Investigators and Collaborators. Predictors of thrombolysis administration in mild stroke: Florida-Puerto Rico Collaboration to reduce stroke disparities. Stroke 2018; 49 (03) 638-645
    CrossrefPubMedSuche in Google Scholar
  • 7 Romano JG, Smith EE, Liang L. et al. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the Get With the Guidelines-Stroke registry. JAMA Neurol 2015; 72 (04) 423-431
    CrossrefPubMedSuche in Google Scholar
  • 8 Powers WJ, Rabinstein AA, Ackerson T. et al. American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (03) e46-e110
    CrossrefPubMedSuche in Google Scholar
  • 9 Berge E, Whiteley W, Audebert H. et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J 2021; 6 (01) I-LXII
    CrossrefPubMedSuche in Google Scholar
  • 10 Sarraj A, Hassan A, Savitz SI. et al. Endovascular thrombectomy for mild strokes: how low should we go?. Stroke 2018; 49 (10) 2398-2405
    CrossrefPubMedSuche in Google Scholar
  • 11 Seners P, Perrin C, Lapergue B. et al; MINOR-STROKE Collaborators. Bridging therapy or IV thrombolysis in minor stroke with large vessel occlusion. Ann Neurol 2020; 88 (01) 160-169
    CrossrefPubMedSuche in Google Scholar
  • 12 Goyal N, Tsivgoulis G, Malhotra K. et al. Medical management vs mechanical thrombectomy for mild strokes: an international multicenter study and systematic review and meta-analysis. JAMA Neurol 2020; 77 (01) 16-24
    CrossrefPubMedSuche in Google Scholar
  • 13 Wolman DN, Marcellus DG, Lansberg MG. et al. Endovascular versus medical therapy for large-vessel anterior occlusive stroke presenting with mild symptoms. Int J Stroke 2020; 15 (03) 324-331
    CrossrefPubMedSuche in Google Scholar
  • 14 Seners P, Dargazanli C, Piotin M. et al; MINOR-STROKE Collaborators. Intended bridging therapy or intravenous thrombolysis alone in minor stroke with basilar artery occlusion. Stroke 2021; 52 (02) 699-702
    CrossrefPubMedSuche in Google Scholar
  • 15 Geng C, Li SD, Zhang DD. et al. Endovascular thrombectomy versus bridging thrombolysis: real-world efficacy and safety analysis based on a nationwide registry study. J Am Heart Assoc 2021; 10 (03) e018003
    CrossrefPubMedSuche in Google Scholar
  • 16 Zhang D, Huang L, Huang Z. et al. Epidemiology of Moyamoya disease in China: a nationwide hospital-based study. Lancet Reg Health West Pac 2021; 18: 100331
    CrossrefPubMedSuche in Google Scholar
  • 17 Tu WJ, Yan F, Chao BH, Cao L, Wang L. Treatment and 1-year prognosis of ischemic stroke in China in 2018: a hospital-based study from Bigdata Observatory Platform for Stroke of China. Stroke 2022; 53 (09) e415-e417
    PubMedSuche in Google Scholar
  • 18 Tu WJ, Xu Y, Liu Y, Du J, Zhao J. Endovascular thrombectomy or bridging therapy in minor ischemic stroke with large vessel occlusion. Thromb Res 2022; 219: 150-154
    CrossrefPubMedSuche in Google Scholar
  • 19 Tu WJ, Xu Y, Chen H, Li J, Du J. Impact of the COVID-19 pandemic lockdown on hospitalizations for cerebrovascular disease and related in-hospital mortality in China: a nationwide observational study. Arch Gerontol Geriatr 2023; 104: 104832
    CrossrefPubMedSuche in Google Scholar
  • 20 Shen Y, Chao BH, Cao L, Tu WJ, Wang LD. Stroke center care and outcome: results from the csppc stroke program. Transl Stroke Res 2020; 11 (03) 377-386
    CrossrefPubMedSuche in Google Scholar
  • 21 Tu WJ, Chao BH, Yan F, Cao L, Wang LD. Stroke unit care for ischemic stroke in China: results of a nation-based study. Intensive Care Med 2020; 46 (07) 1489-1491
    CrossrefPubMedSuche in Google Scholar
  • 22 Yu AY, Hill MD, Coutts SB. Should minor stroke patients be thrombolyzed? A focused review and future directions. Int J Stroke 2015; 10 (03) 292-297
    CrossrefPubMedSuche in Google Scholar
  • 23 National Institute of Neurological Disorders Stroke rt-PA Stroke Study Group. Recombinant tissue plasminogen activator for minor strokes: the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study experience. Ann Emerg Med 2005; 46 (03) 243-252
    CrossrefPubMedSuche in Google Scholar
  • 24 Ingall TJ, O'Fallon WM, Asplund K. et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke 2004; 35 (10) 2418-2424
    CrossrefPubMedSuche in Google Scholar
  • 25 Lan L, Rong X, Li X. et al. Reperfusion therapy for minor stroke: a systematic review and meta-analysis. Brain Behav 2019; 9 (10) e01398
    CrossrefPubMedSuche in Google Scholar
  • 26 Emberson J, Lees KR, Lyden P. et al; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384 (9958): 1929-1935
    CrossrefPubMedSuche in Google Scholar
  • 27 IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012; 379: 2352-2363
    CrossrefPubMedSuche in Google Scholar
  • 28 Crespi V, Braga M, Beretta S, Carolei A, Bignamini A, Sacco S. A practical definition of minor stroke. Neurol Sci 2013; 34 (07) 1083-1086
    CrossrefPubMedSuche in Google Scholar
  • 29 Fischer U, Baumgartner A, Arnold M. et al. What is a minor stroke?. Stroke 2010; 41 (04) 661-666
    CrossrefPubMedSuche in Google Scholar
  • 30 Greisenegger S, Seyfang L, Kiechl S, Lang W, Ferrari J. Austrian Stroke Unit Registry Collaborators. Thrombolysis in patients with mild stroke: results from the Austrian Stroke Unit Registry. Stroke 2014; 45 (03) 765-769
    CrossrefPubMedSuche in Google Scholar
  • 31 Tu WJ, Chao BH, Ma L. et al. Case-fatality, disability and recurrence rates after first-ever stroke: a study from bigdata observatory platform for stroke of China. Brain Res Bull 2021; 175: 130-135
    CrossrefPubMedSuche in Google Scholar
  • 32 Wu S, Wu B, Liu M. et al; China Stroke Study Collaboration. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol 2019; 18 (04) 394-405
    CrossrefPubMedSuche in Google Scholar
  • 33 Suzuki K, Matsumaru Y, Takeuchi M. et al; SKIP Study Investigators. Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the SKIP randomized clinical trial. JAMA 2021; 325 (03) 244-253
    Suche in Google Scholar
  • 34 Seners P, Arquizan C, Fontaine L. et al; MINOR-STROKE-Perfusion Collaborators. Perfusion imaging and clinical outcome in acute minor stroke with large vessel occlusion. Stroke 2022; 53 (11) 3429-3438
    CrossrefPubMedSuche in Google Scholar