Risk factors for unexplained early neurological deterioration after intravenous thrombolysis: a meta-analysis

To explore the risk factors of unexplained early neurological dererioration (END) after IVT, and explore the underlying mechanisms by which these factors contribute to END onset and progression.

We performed a systematic literature search in accordance with PRISMA guidelines, utilizing PubMed, WOS, and EMBASE databases to identify all relevant studies investigating END in AIS patients who received IVT within 4.5 hours of symptom onset.

Out of 2,613 reviewed records, 16 were included in this meta-analysis. The quantitative synthesis of data regarding the incidence of END in acute ischemic stroke (AIS) patients with IVT was 12% (95% confidence interval [CI], 10%-15%). Several factors were identified as significantly associated with post-IVT END, including demographic characteristics (age, male sex), comorbidities (hypertension, diabetes mellitus, atrial fibrillation), medications (antihypertensives, antiplatelets), admission parameters (hyperglycemia, elevated white blood cell count, cholesterol levels, blood pressure readings), timing of treatment, and the presence of large artery atherosclerosis (LAA).

Understanding and monitoring multiple factors associated with END, including other comorbidities, may achieve satisfactory results. The investigation of white blood cells' involvement in END following AIS merits particular attention, as it may guide the development of targeted preventive medications.