Comparison of Functional Recovery and In-Hospital Outcomes Between Thrombolysed and Non-thrombolysed Patients With...

Background Acute ischemic stroke is a major cause of mortality and long-term disability worldwide, contributing substantially to healthcare costs and socioeconomic burden, particularly in low- and middle-income countries. Timely restoration of cerebral perfusion remains the cornerstone of acute stroke management and is associated with improved neurological recovery and functional outcomes. Objective This study's objective is to compare functional recovery, in-hospital mortality, complications, and duration of hospitalization between thrombolysed and non-thrombolysed patients with acute ischemic stroke. Methods This retrospective comparative cohort study was conducted at Shalamar Hospital, Lahore, Pakistan, from December 2022 to December 2025 and included 157 patients diagnosed with acute ischemic stroke. All eligible patients meeting the inclusion criteria during the study period were included through non-probability consecutive sampling. Patients were categorized into thrombolysed (n = 62) and non-thrombolysed (n = 95) groups. Baseline stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were evaluated with the Modified Rankin Scale (mRS). The primary outcome was functional status at discharge. Results Thrombolysed patients had higher baseline NIHSS scores (13.2 ± 4.1 vs. 11.5 ± 3.8, p = 0.011). Despite greater initial severity, a higher proportion achieved favorable functional outcomes (mRS 0-2) compared to non-thrombolysed patients (37 (59.7%) vs. 38 (40.0%) (p = 0.014)). In-hospital mortality was lower in the thrombolysed group (six (9.7%) vs. 18 (18.9%) (p = 0.048)). Symptomatic intracranial hemorrhage occurred more frequently among thrombolysed patients (five (8.1%) vs. two (2.1%) (p = 0.041)). Mean hospital stay was shorter in the thrombolysed group (6.8 ± 2.9 days vs. 8.4 ± 3.7 days, p = 0.003). Conclusion Intravenous thrombolysis was associated with improved functional recovery, lower in-hospital mortality, and shorter hospitalization compared with conservative management. Although thrombolysis was associated with a higher frequency of symptomatic intracranial hemorrhage, the overall findings suggest a favorable benefit-risk profile in appropriately selected patients.