Key result
IVT shows no benefit over DAPT for 90-day functional outcomes in acute stroke with NIHSS ≤5.
Why the study?
Recent studies showed dual antiplatelet therapy is non-inferior to intravenous thrombolysis in acute ischemic stroke with mild disability, prompting an investigation into IVT versus DAPT outcomes in patients with baseline NIHSS ≤ 5.
Does intravenous thrombolysis improve functional outcome in patients with acute ischemic stroke and mild neurological disability compared to dual antiplatelet therapy?
Cohort (n=127)
Does intravenous thrombolysis improve functional outcome in patients with acute ischemic stroke and mild neurological disability compared to dual antiplatelet therapy?
p-value: p=0.484
In patients with acute ischemic stroke and mild neurological deficit, IVT accelerated early neurological recovery but did not significantly improve 90-day functional outcomes compared to DAPT.
IVT adds no mRS benefit over DAPT in mild AIS; reinforces noninferiority while cautioning higher hemorrhagic transformation risk.
Background and aims Results of recent studies showed that dual antiplatelet therapy (DAPT) is non-inferior to intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) and mild neurological disability. The aim of our study was to investigate an impact of IVT on functional outcome in patients with AIS and baseline NIH Stroke Scale/Score (NIHSS) ≤ 5 compared to DAPT. Methods We retrospectively included patients from the register of hospitalized AIS patients with baseline NIHSS ≤ 5 who were treated with IVT or DAPT. Patients were matched according to baseline clinical and demographic characteristics. Functional outcome was assessed by the modified Rankin score (mRS). Data was analyzed using standard statistical tests in SPSS Statistics 26.0 software. Results We included 127 patients (mean age 59.9±15.7 years, 58.2% of males), 72 patients treated with IVT and 55 with DAPT. Apart from diabetes mellitus (p=0.04) and cardiomyopathy (p<0.01) which were more prevalent in DAPT group, there were no other significant difference between groups. In our group of patients, IVT was associated with lower NIHSS after 24 hours (p=0.039) and at discharge (p=0.033), but without impact on mRS at discharge (p=0.473) and mRS after 90 days (p=0.484). Hemorrhagic transformation of infarct was more common in IVT group (p=0.05), but without influence on symptomatic intracranial hemorrhage (sICH) occurrence (p=0.505). Conclusions In our study, patients with AIS and mild neurological deficit who were treated with IVT demonstrated a tendency toward accelerated recovery; however, this treatment did not significantly affect overall functional outcome when compared to DAPT, while maintaining comparable safety profiles. Conflict of interest All authors have noting to disclose.
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Ivanovic et al. (2026) conducted a cohort in Acute ischemic stroke with mild neurological disability (n=127). Intravenous thrombolysis (IVT) vs. Dual antiplatelet therapy (DAPT) was evaluated on Functional outcome assessed by modified Rankin score (mRS) after 90 days (p=0.484). Intravenous thrombolysis did not significantly improve functional outcome at 90 days compared to dual antiplatelet therapy in patients with acute ischemic stroke and NIHSS ≤ 5 (p=0.484).
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