Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients
Abstract Background The definition of minor ischemic stroke (MIS) is a topic of debate, however, the most accepted definition is a stroke with National Institutes of Health Stroke Scale (NIHSS) ≤ 5. Intravenous thrombolysis (IVT) is a crucial treatment option for acute ischemic stroke (AIS) includin...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12883-024-04000-8 |
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| author | Mostafa Hossam El Din Moawad Talal Salem Anas Alaaeldin Youssef Elaraby Peter D. Awad Amr Ahmed Khalifa Ahmed El Naggar Khaled Ashraf Mohamed Mohamed Elhalal Mostafa Badr Ramy Abdelnaby |
| author_facet | Mostafa Hossam El Din Moawad Talal Salem Anas Alaaeldin Youssef Elaraby Peter D. Awad Amr Ahmed Khalifa Ahmed El Naggar Khaled Ashraf Mohamed Mohamed Elhalal Mostafa Badr Ramy Abdelnaby |
| author_sort | Mostafa Hossam El Din Moawad |
| collection | DOAJ |
| description | Abstract Background The definition of minor ischemic stroke (MIS) is a topic of debate, however, the most accepted definition is a stroke with National Institutes of Health Stroke Scale (NIHSS) ≤ 5. Intravenous thrombolysis (IVT) is a crucial treatment option for acute ischemic stroke (AIS) including: alteplase, recombinant human tissue-type plasminogen activator (r-tPA), and the recently approved tenecteplase. However, there is a debate regarding its safety and efficacy. Therefore, our objective was to determine the safety and efficacy of IVT in treating minor stroke patients (NIHSS ≤ 5). Methods Using the search strategy assigned which was based on three keywords: “mild” or “minor”, “stroke”, and “intravenous thrombolysis”, we searched for eligible articles on PubMed, Web of Science, Embase, and Scopus from inception till 10th January 2024. We conducted this meta-analysis using the random effect model to account for the heterogeneity among the studies. For the dichotomous variables, we calculated the odds ratio (OR) from the event and total of these variables. While for the continuous variables, we calculated the mean difference (MD) of these variables. Pooling of OR for the occurrence of events was also conducted. Results A total of 21 articles with 93,057 patients with MIS were included. The mean age of the participants ranged from 62.3 to 79.6. Most of the included patients had comorbidities such as hypertension, diabetes, previous stroke, smoking, atrial fibrillation, and hyperlipidemia. Of these, 10,850 received IVT while 82,207 did not. The use of IVT was statistically significant associated with 90-day modified Rankin score (mRs) 0–1 when compared with control with OR of 1.67 (95%CI: 1.46, 1.91, p < 0.00001) and was statistically significantly associated with improvement of NIHSS on discharge with OR of 2.19 (95%CI: 1.56, 3.08, p < 0.00001). In terms of safety outcomes, IVT has proven a safe profile, as there was no significant difference in intracranial hemorrhage (ICH) and mortality rates between the IVT and control groups with OR of 1.75 (95CI: 0.95, 3.23, p = 0.07) and 0.93 (95%CI: 0.77, 1.11, p = 0.41), respectively. Conclusion Although some studies have not found any benefits of IVT in MIS patients, a substantial body of literature strongly endorses IVT as an effective and safe treatment for MIS. IVT has been shown to improve the mRs and NIHSS scores at the 90-day mark without an increased risk of ICH or mortality. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-8207ec9dda5b4cf98cb9dc85b9155b0d2025-01-26T12:39:23ZengBMCBMC Neurology1471-23772025-01-0125111410.1186/s12883-024-04000-8Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patientsMostafa Hossam El Din Moawad0Talal Salem1Anas Alaaeldin2Youssef Elaraby3Peter D. Awad4Amr Ahmed Khalifa5Ahmed El Naggar6Khaled Ashraf Mohamed7Mohamed Elhalal8Mostafa Badr9Ramy Abdelnaby10Faculty of Medicine, Suez Canal UniversityFaculty of Medicine, Masaryk UniversityFaculty of Medicine, Cairo UniversityFaculty of Medicine, New Giza UniversityDepartment of Public Health, Theodor Bilharz Research InstituteFaculty of Medicine, Cairo UniversityFaculty of Medicine, Cairo UniversityFaculty of Medicine, Cairo UniversityNeuroradiology Department, RWTH University Hospital of AachenDepartment for Epileptology, Bonn UniversityDepartment of Neurology, RWTH Aachen UniversityAbstract Background The definition of minor ischemic stroke (MIS) is a topic of debate, however, the most accepted definition is a stroke with National Institutes of Health Stroke Scale (NIHSS) ≤ 5. Intravenous thrombolysis (IVT) is a crucial treatment option for acute ischemic stroke (AIS) including: alteplase, recombinant human tissue-type plasminogen activator (r-tPA), and the recently approved tenecteplase. However, there is a debate regarding its safety and efficacy. Therefore, our objective was to determine the safety and efficacy of IVT in treating minor stroke patients (NIHSS ≤ 5). Methods Using the search strategy assigned which was based on three keywords: “mild” or “minor”, “stroke”, and “intravenous thrombolysis”, we searched for eligible articles on PubMed, Web of Science, Embase, and Scopus from inception till 10th January 2024. We conducted this meta-analysis using the random effect model to account for the heterogeneity among the studies. For the dichotomous variables, we calculated the odds ratio (OR) from the event and total of these variables. While for the continuous variables, we calculated the mean difference (MD) of these variables. Pooling of OR for the occurrence of events was also conducted. Results A total of 21 articles with 93,057 patients with MIS were included. The mean age of the participants ranged from 62.3 to 79.6. Most of the included patients had comorbidities such as hypertension, diabetes, previous stroke, smoking, atrial fibrillation, and hyperlipidemia. Of these, 10,850 received IVT while 82,207 did not. The use of IVT was statistically significant associated with 90-day modified Rankin score (mRs) 0–1 when compared with control with OR of 1.67 (95%CI: 1.46, 1.91, p < 0.00001) and was statistically significantly associated with improvement of NIHSS on discharge with OR of 2.19 (95%CI: 1.56, 3.08, p < 0.00001). In terms of safety outcomes, IVT has proven a safe profile, as there was no significant difference in intracranial hemorrhage (ICH) and mortality rates between the IVT and control groups with OR of 1.75 (95CI: 0.95, 3.23, p = 0.07) and 0.93 (95%CI: 0.77, 1.11, p = 0.41), respectively. Conclusion Although some studies have not found any benefits of IVT in MIS patients, a substantial body of literature strongly endorses IVT as an effective and safe treatment for MIS. IVT has been shown to improve the mRs and NIHSS scores at the 90-day mark without an increased risk of ICH or mortality.https://doi.org/10.1186/s12883-024-04000-8Acute ischemic strokeTissue Plasminogen ActivatorEfficacySafetyIntracranial hemorrhage |
| spellingShingle | Mostafa Hossam El Din Moawad Talal Salem Anas Alaaeldin Youssef Elaraby Peter D. Awad Amr Ahmed Khalifa Ahmed El Naggar Khaled Ashraf Mohamed Mohamed Elhalal Mostafa Badr Ramy Abdelnaby Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients BMC Neurology Acute ischemic stroke Tissue Plasminogen Activator Efficacy Safety Intracranial hemorrhage |
| title | Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients |
| title_full | Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients |
| title_fullStr | Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients |
| title_full_unstemmed | Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients |
| title_short | Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients |
| title_sort | safety and efficacy of intravenous thrombolysis a systematic review and meta analysis of 93 057 minor stroke patients |
| topic | Acute ischemic stroke Tissue Plasminogen Activator Efficacy Safety Intracranial hemorrhage |
| url | https://doi.org/10.1186/s12883-024-04000-8 |
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