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Intravenous thrombolysis for minor stroke and rapidly improving symptoms: a quantitative overview

Qiang Huang1, Qingfeng Ma, Jianping Jia

  • 1Department of Neurology, Xuanwu Hospital of Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, China.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|July 27, 2014
PubMed

Insights

Minor stroke and rapidly improving symptoms (MRIS) patients may not benefit from intravenous thrombolysis (IVT) due to early risks. However, MRIS treated with IVT showed lower bleeding and mortality risks compared to non-minor stroke patients.

Area of Science:

  • Neurology
  • Stroke Medicine
  • Clinical Research

Background:

  • Minor stroke and rapidly improving symptoms (MRIS) are typically excluded from intravenous thrombolysis (IVT).
  • The risk-benefit profile of IVT in MRIS patients remains incompletely understood.
  • Existing data often excludes MRIS, limiting evidence on IVT efficacy and safety in this subgroup.

Purpose of the Study:

  • To evaluate the functional outcomes and safety of IVT in patients with minor stroke and rapidly improving symptoms.
  • To compare the prognosis of MRIS patients receiving IVT with those not receiving IVT.
  • To compare the outcomes of MRIS patients receiving IVT with non-minor stroke patients receiving IVT.

Main Methods:

  • A systematic literature search was conducted on PubMed for studies published up to December 2013.
  • Included studies focused on the functional outcomes and safety (symptomatic intracranial hemorrhage, mortality) of MRIS after IVT.
  • Statistical analysis was performed using RevMan5.1 software, including odds ratios and confidence intervals.

Main Results:

  • A total of 13 citations involving 2905 MRIS cases were analyzed.
  • Favorable discharge outcomes were more frequent in non-thrombolysed MRIS compared to thrombolysed MRIS (OR 0.50).
  • No significant difference in 3-month outcomes was observed between thrombolysed and non-thrombolysed MRIS (OR 0.99).
  • MRIS patients receiving IVT had a significantly lower rate of symptomatic intracranial hemorrhage (SICH) compared to non-minor stroke patients (3.68% vs 5.77%).
  • MRIS patients receiving IVT had a significantly lower mortality rate compared to non-minor stroke patients (OR 0.16).

Conclusions:

  • MRIS patients may not experience significant short-term or 3-month functional benefits from IVT, potentially due to increased early risks.
  • Despite potential lack of short-term benefit, IVT in MRIS patients is associated with a significantly lower risk of SICH and death compared to non-minor stroke patients receiving IVT.
  • Further research is needed to refine IVT guidelines for MRIS patients, balancing potential risks and benefits.

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