Abstract
Background and purpose: It is unclear whether intravenous thrombolysis (IVT) outperforms early dual antiplatelet therapy (DAPT) in the acute setting of mild ischemic stroke. The aim of this study was to compare early safety and efficacy of IVT to DAPT.
Methods: Data of mild non-cardioembolic stroke patients with admission NIHSS <=3 who received IVT or early DAPT in the period 2018-2021 were extracted from a nationwide, prospective stroke unit registry. Study endpoints included symptomatic intracerebral hemorrhage (sICH), early neurological deterioration ≥4 NIHSS points (END), and 3-months functional outcome by modified Rankin Scale (mRS).
Results: 1195 mild stroke patients treated with IVT and 2625 treated with DAPT were included. IVT patients were younger (68.1 versus 70.8 years), had less hypertension (72.8% versus 83.5%), diabetes (19% versus 28.8%) and history of myocardial infarction (7.6% versus 9.2%) and slightly higher admission NIHSS scores (median 2 versus median 1) as compared to DAPT patients. After propensity score matching and multivariable adjustment, IVT was associated with sICH (4 (1.2%) vs 0), END (aOR 2.8, CI 1.1-7.5), and there was no difference in mRS 0-1 at 3 months (aOR 1.3, CI 0.7-2.6).
Conclusions: This analysis from a prospective nationwide stroke unit network indicates that IVT is not superior to DAPT in the setting of mild non-cardioembolic stroke and may eventually be associated with harm. Further research focusing on acute therapy of mild stroke is highly warranted.
Classification of Evidence: This study provides Class III evidence that IVT is not superior to dual antiplatelet therapy in patients with acute mild (NIHSS<=3) non-cardioembolic stroke. The study lacks the statistical precision to exclude clinically important superiority of either therapy.
- Received November 15, 2022.
- Accepted in final form May 4, 2023.
- © 2023 American Academy of Neurology
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