Intravenous Thrombolysis for Minor Ischemic Stroke in Chinese Populations: A Secondary Meta-Analysis of Comparative...

The effectiveness and safety of intravenous thrombolysis (IVT) in minor ischemic stroke (MIS) remain uncertain in Chinese populations. We performed a secondary meta-analysis of cohort studies identified in a systematic review and meta-analysis, restricting the analysis to studies conducted in Chinese populations with MIS, defined as NIHSS ≤5 or a more restrictive threshold, comparing IVT with non-IVT management. Outcomes included excellent functional outcome (mRS 0-1), early NIHSS improvement, within-group change in NIHSS after IVT, all-cause mortality, and study-reported intracranial hemorrhage (ICH). Pooled odds ratios (ORs) and standardized mean differences (SMDs), each with 95% confidence intervals (CIs), were calculated using random-effects models. Six cohort studies involving 1676 IVT-treated and 4162 control patients were included. IVT was associated with higher odds of mRS 0-1 (OR = 1.69; 95% CI: 1.41-2.03; I² = 0.8%) and early NIHSS improvement (OR = 2.94; 95% CI: 2.37-3.64; I² = 0.0%). A within-IVT pre-post analysis showed lower NIHSS scores after treatment (SMD = -1.64; 95% CI: -2.98 to -0.29; I² = 96.8%), although substantial heterogeneity and the absence of a concurrent comparison in this analysis limit causal interpretation. No statistically significant differences were detected in pooled all-cause mortality (OR = 1.04; 95% CI: 0.29-3.74; I² = 0.0%) or study-reported ICH (OR = 1.48; 95% CI: 0.74-2.95; I² = 22.9%). In Chinese patients with MIS represented in observational cohorts, IVT was associated with favorable functional and neurological outcomes. However, residual confounding, differences in clinical phenotypes, and heterogeneity in outcome definitions and follow-up require cautious interpretation of these findings.