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 vs. 0, aOR: 1.49 (1.05-2.11); 4 vs. 0, aOR: 2.36 (1.68-3.33); 5 vs. 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.

Automated summary

This study investigated short-term outcomes and predictors for favorable functional outcome in mild stroke patients treated with rtPA in China. The results showed that only 18.5% of patients had an unfavorable functional outcome at discharge, with factors such as age, diabetes, time window, and NIHSS score being independent risk factors for poorer outcomes. The study suggests that rtPA is safe and effective for mild stroke patients, but further research is needed to confirm these findings.