Intravenous Thrombolysis is Effective in Mild Stroke Patients with an Admission NIHSS Score of 3 to 5.

Kai Zhang, Lin Han
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Abstract

Background and purpose: The role of intravenous thrombolysis in patients with acute mild ischemic stroke remains highly controversial. Therefore, this study aims to analyze the efficacy and safety of intravenous thrombolysis in patients with mild ischemic stroke based on admission National Institutes of Health Stroke Scale (NIHSS) score.

Methods: The present study enrolled 507 patients with acute mild ischemic stroke admitted within 4.5 hours of symptom onset with an admission NIHSS score of 0 to 5. Patients were assigned to two groups based on admission NIHSS scores of 0 to 2 and 3 to 5, and subsequent analyses compared functional outcomes between thrombotic and non-thrombotic patients within these groups. The primary outcome was a modified Rankin score (mRS) of 0 or 1 at 90 days, representing functional independence. The safety outcomes were symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END), and the rate of stroke recurrence within 90 days.

Results: Among the 267 patients with NIHSS scores of 0 to 2, 112 (41.9%) patients received intravenous thrombolysis. Overall, thrombolysis administration did not significantly improve the patient's functional prognoses at 90 days (adjusted OR=1.046, 95%CI=0.587-1.863, p = 0.878). However, there was a marked increase in the risk of sICH (p = 0.030). Of the 240 patients with NIHSS scores of 3 to 5, 155 (64.6%) patients received intravenous thrombolysis, resulting in a significant improvement in 90-day functional prognosis (adjusted OR=3.284, 95%CI=1.876- 5.749, p < 0.001) compared to those that did not receive thrombolysis intervention. Importantly, there was no significant increase in sICH incidence (adjusted OR=2.770, 95%CI=0.313-24.51, p = 0.360). There were no statistically significant differences in END or the rate of stroke recurrence within 90 days between thrombotic and non-thrombotic groups.

Conclusions: Intravenous thrombolysis is safe and effective in patients with baseline NIHSS scores of 3 to 5. In contrast, it did not improve 90-day functional outcomes in patients with NIHSS scores of 0 to 2 and instead increased the risk of sICH.

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静脉溶栓对入院NIHSS评分为3-5的轻度中风患者有效。
背景和目的:静脉溶栓在急性轻度缺血性脑卒中患者中的作用仍然存在很大争议。因此,本研究旨在根据美国国立卫生研究院卒中量表(NIHSS)评分,分析轻度缺血性卒中患者静脉溶栓的有效性和安全性。方法:本研究纳入了507名在症状出现4.5小时内入院的急性轻度缺血性卒中患者,入院NIHSS评分为0-5。根据入院NIHSS评分0至2和3至5,将患者分为两组,随后的分析比较了这些组中血栓性和非血栓性患者的功能结果。主要结果是在90天时改良的Rankin评分(mRS)为0或1,代表功能独立性。安全性结果为症状性颅内出血(sICH)、早期神经系统恶化(END)和90天内卒中复发率。结果:在267例NIHSS评分为0-2的患者中,112例(41.9%)接受了静脉溶栓治疗。总的来说,溶栓治疗并没有显著改善患者90天的功能预后(校正OR=1.046,95%CI=0.587-1.863,p=0.878)。然而,sICH的风险显著增加(p=0.030)。在240名NIHSS评分为3-5的患者中,155名(64.6%)患者接受了静脉溶栓治疗,与未接受溶栓干预的患者相比,90天功能预后显著改善(校正OR=3.284,95%CI=1.876-5.749,p<0.001)。重要的是,sICH的发生率没有显著增加(校正OR=2.770,95%CI=0.313-24.51,p=0.360)。血栓形成组和非血栓形成组之间的END或90天内卒中复发率没有统计学上的显著差异。结论:对于NIHSS基线评分为3-5分的患者,静脉溶栓是安全有效的。相反,在NIHSS评分为0-2的患者中,它并没有改善90天的功能结果,反而增加了sICH的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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