Background: The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase.
Methods: This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes.
Results: A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22– 8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17– 4.50). There was an association of alteplase with better gait speed in the restricted sample of age > 60 (OR, 0.14; 95% CI, 0.02– 0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91– 3.55) and depression (OR, 1.54; 95% CI, 0.17– 2.91) in female.
Conclusion: Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0– 5. Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future.
Keywords: alteplase, minor stroke, ischemic, outcomes