Intravenous Thrombolysis Versus Antiplatelet Therapy for Patients with Minor Acute Ischemic Stroke: A Systematic Review and Meta-analysis
Marianna Gerardo Hidalgo Santos Jorge Leite1, Lucca Moreira Lopes2, Eric Pasqualotto3, Maria Eduarda Cavalvanti Souza4, Renan Yuji Ura Sudo5, Francisco Cezar Aquino de Moraes6, Artur Menegaz de Almeida7, Victória Morbach Siebel8, Agostinho Pinheiro9
1Faculdade Santa Marcelina, 2Faculdade de Ciências Médicas de Santos, 3Federal University of Santa Catarina, 4Universidade de Pernambuco, 5Universidade Federal Grande Dourados, 6Federal University of Pará, 7Universidade Federal de Mato Grosso, 8Universidade Feevale, 9Mass General Brigham Neurology Residency
Objective:
To assess the efficacy and safety of IV-Thrombolysis compared with antiplatelet therapy in patients with minor acute ischemic stroke.
Background:
Antiplatelet therapy has been the conventional treatment for the management of minor non disabling acute ischemic stroke. However, IV-Thrombolysis has emerged as an adequate alternative for those patients, requiring comprehensive research to assess the efficacy and safety of such strategy.
Design/Methods:
We performed a systematic review and meta-analysis comparing IV-Thrombolysis (Alteplase) with antiplatelet therapy (dual antiplatelet therapy (DAPT) or Aspirin) in patients with minor acute ischemic stroke. PubMed, Embase, and Cochrane were searched for randomized controlled trials or cohort studies with propensity scores. A random-effects model was used to calculate the risk ratios (RRs) with 95% confidence intervals (CIs). Review Manager 5.4 was used for statistical analysis.
Results:
A total of four studies comprising 2,499 patients were included, of whom 1,093 (44%) were randomized to IV-Thrombolysis. There was no significant difference between IV-Thrombolysis and DAPT for stroke (RR 1.10; 95%CI 0.67-1.81; p=0.69), modified Rankin Scale (mRS) scores 0-1 (RR 1.00; 95%CI 0.96-1.05; p=0.84), and mRS 0-2 (RR 1.01; 95%CI 0.98-1.03; p=0.62). In addition, there was no significant difference between IV-Thrombolysis and Aspirin for stroke (RR 1.01; 95%CI 0.61-1.69; p=0.96), mortality (RR 0.50; 95%CI 0.08-3.21; p=0.46), mRS scores 0-1 (RR 1.00; 95%CI 0.89-1.13; p=0.95), and mRS 0-2 (RR 1.01; 95%CI 0.97-1.06; p=0.58).
Conclusions:
In this meta-analysis of patients with minor acute ischemic stroke, IV-Thrombolysis showed efficacy and safety equivalent to antiplatelet therapy with DAPT or Aspirin.