Standard Antiplatelet Therapy Versus Thrombolysis in Acute Spontaneous Spinal Cord Infarction: A Propensity...

Area of Science:

• Neurology
• Vascular Neurology
• Neurosurgery

Background:

• Spinal cord infarction (SCI) is a rare stroke subtype lacking established acute treatment guidelines.
• Thrombolytic therapy is sometimes used empirically for SCI, extrapolated from cerebral stroke protocols, but lacks comparative effectiveness data.
• This study investigates outcomes of standard care versus thrombolysis in acute spontaneous SCI.

Purpose of the Study:

• To compare the effectiveness of standard care versus thrombolytic therapy in patients with acute spontaneous spinal cord infarction.
• To evaluate all-cause mortality, readmission rates, and rehabilitation utilization at 180 days post-treatment.

Main Methods:

• A retrospective cohort study utilizing the TriNetX Global Collaborative Network database.
• Adult patients with acute SCI (ICD-10-CM code G95.11) were analyzed, excluding those who underwent aortic repair.
• Propensity score matching (1:1) was used to balance 68 covariates between the standard care (antiplatelet therapy) and thrombolysis (alteplase or tenecteplase) groups.

Main Results:

• After matching, 96 patients were in each cohort. Standard care was associated with significantly lower mortality (13.5% vs. 29.2%; P=0.008) compared to thrombolysis.
• 180-day survival was higher with standard care (84.27%) versus thrombolysis (68.69%) (log-rank P=0.008).
• No significant differences were observed in 180-day readmission rates (14.6% vs. 16.7%) or rehabilitation utilization (43.8% vs. 49.0%) between the groups.

Conclusions:

• Standard care for spontaneous SCI was associated with significantly lower mortality than thrombolysis.
• The findings suggest caution regarding off-label thrombolytic use in SCI and support considering conservative management.
• Further high-quality evidence is needed to guide acute treatment strategies for spinal cord infarction.