What is the clinical evidence from this study?

Study design: Review. Population: Minor strokes. Intervention: Thrombolysis vs. Antiplatelet therapy. Primary outcome: Favourable functional outcome at 90 days.

August 3, 2024Stroke and Vascular Neurology7 citationsOpen Access

Should patients with minor strokes be given thrombolytics?

Q: What does this research mean for the field?

Thrombolysis versus antiplatelet therapy does not increase the likelihood of favorable functional outcome at 90 days among patients with minor non-disabling acute ischemic strokes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

XWXun Wang YDYi Dong QDQiang Dong

Key Result

Thrombolysis versus antiplatelet therapy did not increase the likelihood of favorable functional outcome at 90 days among patients with minor non-disabling acute ischemic strokes.

Structured PICO

Does thrombolysis improve favourable functional outcome at 90 days compared to antiplatelet therapy in patients with minor strokes?

Population

Patients with minor strokes (including minor non-disabling acute ischaemic strokes)

Intervention

Thrombolysis (tissue-type plasminogen activator or tenecteplase)

Comparator

Antiplatelet therapy (e.g., aspirin alone or dual antiplatelet treatment with aspirin and clopidogrel) or standard of care

Outcome

Favourable functional outcome at 90 dayshard clinical

This narrative review highlights that recent evidence does not support the use of thrombolysis over antiplatelet therapy for improving 90-day functional outcomes in patients with minor non-disabling acute ischemic strokes.

Abstract

Mild stroke symptoms are cited as the reason for not using tissue-type plasminogen activator in 29-43% of time-eligible patients. Previous studies suggested that not all of these patients had a good recovery or even survival to hospital discharge. Since then, stroke guidelines worldwide recommended thrombolysis in minor but disabling strokes.Dual antiplatelet treatment with aspirin and clopidogrel was more effective than aspirin alone for reducing subsequent events in patients with minor stroke if started within 24 hours of onset in both CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) and POINT (Platelet-Oriented Inhibition in New TIA and Minor Ischaemic Stroke) trials. Recently, both PRISMS (The Potential of rtPA for Ischemic Strokes With Mild Symptoms) trial and TEMPO-2 (Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) trial showed that treatment with thrombolysis versus antiplatelet did not increase the likelihood of favourable functional outcome at 90 days among patients with minor non-disabling acute ischaemic strokes. Therefore, a narrative review on thrombolysis for patients with minor strokes from published studies may help practicing clinicians.

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