Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Sykora, M; Krebs, S; Miksova, D; Badic, I; Gattringer, T; Fandler-Höfler, S; Marko, M; Greisenegger, S; Knoflach, M; Lang, W; Ferrari, J, , for, Austria, Stroke, Unit, Collaborators.
IV Thrombolysis vs Early Dual Antiplatelet Therapy in Patients With Mild Noncardioembolic Ischemic Stroke.
Neurology. 2023; 101(9):e933-e939
Doi: 10.1212/WNL.0000000000207538
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- Co-Autor*innen der Med Uni Graz
- Fandler-Höfler Simon
- Gattringer Thomas
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- Abstract:
- BACKGROUND OBJECTIVES: It is unclear whether IV thrombolysis (IVT) outperforms early dual antiplatelet therapy (DAPT) in the acute setting of mild ischemic stroke. The aim of this study was to compare the early safety and efficacy of IVT with that of DAPT. METHODS: Data of mild noncardioembolic stroke patients with admission NIH Stroke Scale (NIHSS) score ≤3 who received IVT or early DAPT in the period 2018-2021 were extracted from a nationwide, prospective stroke unit registry. Study endpoints included symptomatic intracerebral hemorrhage (sICH), early neurologic deterioration ≥4 NIHSS points (END), and 3-month functional outcome by modified Rankin scale (mRS). RESULTS: A total of 1,195 mild stroke patients treated with IVT and 2,625 patients treated with DAPT were included. IVT patients were younger (68.1 vs 70.8 years), had less hypertension (72.8% vs 83.5%), diabetes (19% vs 28.8%), and a history of myocardial infarction (7.6% vs 9.2%), and slightly higher admission NIHSS scores (median 2 vs median 1) when compared with DAPT patients. After propensity score matching and multivariable adjustment, IVT was associated with sICH (4 [1.2%] vs 0) and END (adjusted odds ratio [aOR] 2.8, 95% CI 1.1-7.5), and there was no difference in mRS 0-1 at 3 months (aOR 1.3, 95% CI 0.7-2.6). DISCUSSION: This analysis from a prospective nationwide stroke unit network indicates that IVT is not superior to DAPT in the setting of mild noncardioembolic stroke and may eventually be associated with harm. Further research focusing on acute therapy of mild stroke is highly warranted. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IVT is not superior to DAPT in patients with acute mild (NIHSS score ≤3) noncardioembolic stroke. The study lacks the statistical precision to exclude clinically important superiority of either therapy.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Fibrinolytic Agents - therapeutic use
- Platelet Aggregation Inhibitors - therapeutic use
- Ischemic Stroke - drug therapy
- Thrombolytic Therapy - adverse effects
- Treatment Outcome - administration & dosage
- Stroke - therapy
- Cerebral Hemorrhage - etiology
- Brain Ischemia - complications, drug therapy