Intravenous Thrombolysis in Chinese Patients with Mild Acute Ischemic Stroke

Background: Mild stroke accounts for more than a half of all stroke patients, and short-term outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) have not been fully investigated in this group.

Methods: Our study investigated short-term outcomes and predictors for a favorable functional outcome at discharge in mild stroke patients with IV rtPA. 6,752 mild stroke patients in the China Stroke Center Alliance with a clinical diagnosis of acute ischemic stroke, within 4.5 hours from symptom onset, with a baseline National Institutes of Health Stroke Scale score ≤5 and received rt-PA treatment were included in this retrospective analysis. Univariable and multivariable analyses were performed to identify factors independently associated with a favorable functional outcome.

Results: Only 18.5% had an unfavorable functional outcome at discharge, 91.1% were discharged home, 89.9% could ambulate independently, 95.9% had a length of stay of 3 days or longer and 1.9% had sICH. A multivariable Logistic regression model identified that age >80 years [adjusted odds ratio (aOR): 1.57 (1.1-2.25)], diabetes mellitus [aOR: 1.35 (1.16-1.58)], 3-4.5 h time window [aOR: 1.43 (1.26-1.63)] and NIHSS score [3 0, aOR: 1.49 (1.05-2.11); 4 0, aOR: 2.36 (1.68-3.33); 5 0, aOR: 2.51 (1.77-3.56)] were independent risk factors for mRS >2 with hospital region, hospital level and hypertension as covariates.

Conclusions: Our findings suggest that tPA is safe and effective in mild stroke patients with age ≤80 within the 3 hour time window and in those without diabetes mellitus, further studies are needed to confirm the findings.