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March 10, 2025Thrombosis JournalOpen Access

Outcomes and risk factors for functional prognosis at 3 months after intravenous thrombolysis with r-tPA in patients with acute ischemic stroke: a retrospective cohort study

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Why the study?

Although IVT with rt-PA is the preferred treatment for AIS, only about half of patients experience positive outcomes, warranting identification of predictors for unfavorable 3-month outcomes.

Population

3805 consecutive patients with AIS who received IVT

Comparison

Patients with poor outcome (mRS 3-6) vs good outcome (mRS 0-2)

Design

Retrospective cohort study

Follow-up

3 months

Key result

Higher baseline NIHSS scores (OR 1.156) and advancing age (OR 1.037) were significant independent predictors of poor functional outcomes at 3 months in patients with acute ischemic stroke receiving intravenous thrombolysis.

Authors

YXYayun XuHFHaixing FengZHZhengzheng Huang

Discussion

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Member takes

Overview

Supports risk stratification by age and NIHSS in IVT recipients; hypothesis-generating for modifiable outcome interventions.

Study Design

Type

Cohort (n=3,805)

Multicenter

Yes

Structured PICO

P
Population
3,805 consecutive patients diagnosed with acute ischemic stroke (AIS) who received intravenous thrombolysis (IVT) within 4.5 hours of symptom onset, age ≥18 years, and baseline NIHSS score ≤25.
I
Intervention
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA)
O
Outcome
Poor clinical outcome at 3 months, defined as a modified Rankin scale score (mRS) of 3-6hard clinical

Main Result

Effect estimate: OR 1.156 (95% CI 1.116-1.197)

p-value: p=<0.001

Advancing age and higher baseline NIHSS scores are independent predictors of poor functional outcomes at 3 months in patients with acute ischemic stroke receiving intravenous thrombolysis.

Limitations

  • The study populations consisted of hospital-based cohorts, suggesting the need for validation of the model in unselected patients across various clinical settings.
  • The relatively short observation time compared to the recovery period of stroke may not fully capture the prognosis of stroke.
  • The exclusive enrollment of Chinese patients treated with IVT necessitates further testing of the results in non-Chinese populations.

Cite This Study

Xu et al. (2025) conducted a cohort in Acute ischemic stroke (n=3,805). Intravenous thrombolysis with r-tPA was evaluated on Poor functional outcome (mRS 3-6) (OR 1.156, 95% CI 1.116-1.197, p=<0.001). Higher baseline NIHSS scores (OR 1.156) and advancing age (OR 1.037) were significant independent predictors of poor functional outcomes at 3 months in patients with acute ischemic stroke receiving intravenous thrombolysis.

synapsesocial.com/papers/6a159f30d64fa333899fe163https://doi.org/10.1186/s12959-025-00704-0
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Arterial Occlusive Lesions Recanalize More Frequently in Women Than in Men After Intravenous Tissue Plasminogen Activator Administration for Acute Stroke2005 · 103 citations
  2. 2Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke2024 · 8 citations
  3. 3Trends in sex differences of functional outcome after intravenous thrombolysis in patients with acute ischemic stroke2024 · 9 citations
  4. 4Age and National Institutes of Health Stroke Scale Score Within 6 Hours After Onset Are Accurate Predictors of Outcome After Cerebral Ischemia2003 · 414 citations
  5. 5Neuroinflammatory Mechanisms in Ischemic Stroke: Focus on Cardioembolic Stroke, Background, and Therapeutic Approaches2020 · 620 citations