[Efficacy and safety of intravenous thrombolysis in patients with mild acute ischemic stroke].

OBJECTIVES

To evaluate the efficacy and safety of intravenous thrombolysis in patients with mild acute ischemic stroke (AIS).

METHODS

In this retrospective cohort study, adult patients with mild AIS within 4.5 hours of onset between July 2009 and December 2024 were enrolled from four hospitals in Zhejiang province. Mild AIS was defined as a National Institutes of Health Stroke Scale (NIHSS) score ≤5, with a limb motor NIHSS score of 0, and a NIHSS score ≥2 in any of the following items: gaze, visual fields, facial palsy, limb ataxia, sensation, language, dysarthria, or neglect. Logistic regression and general linear models were used to assess the impact of intravenous thrombolysis on 3-month functional outcomes and safety endpoints.

RESULTS

Among 347 enrolled patients, 206 (59.4%) received intravenous thrombolysis. The proportion of patients achieving a favorable functional outcome (modified Rankin Scale score 0-1) at 3 months was significantly higher in the thrombolysis group than that in the non-thrombolysis group (76.2% vs. 66.0%, adjusted OR=1.729, 95%CI: 1.016-2.940, P<0.05). The thrombolysis group also had a significantly lower all-cause mortality rate (1.0% vs. 12.8%, adjusted OR=0.074, 95%CI:0.015-0.379, P<0.01). Safety analysis showed hemorrhagic transformation in 5.8%, parenchymal hemorrhage in 1.9%, and symptomatic intracranial hemorrhage in 2.9% within 24 hours in the thrombolysis group, compared with 3.5% hemorrhagic transformation in the non-thrombolysis group, with no statistically significant differences between the two groups (all P>0.05).

CONCLUSIONS

Intravenous thrombolysis can significantly improve 3-month functional outcomes and reduce mortality in patients with mild AIS, without increasing the risk of hemorrhagic transformation.