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. 2013;8(3):e59420.
doi: 10.1371/journal.pone.0059420. Epub 2013 Mar 19.

The Outcome of Patients With Mild Stroke Improves After Treatment With Systemic Thrombolysis

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Free PMC article

The Outcome of Patients With Mild Stroke Improves After Treatment With Systemic Thrombolysis

Xabier Urra et al. PLoS One. .
Free PMC article

Abstract

Introduction: In up to one third of patients with mild stroke suitable to receive systemic thrombolysis the treatment is not administered because the treating physicians estimate a good spontaneous recovery. However, it is not settled whether the fate of these patients is equivalent to those who are thrombolysed.

Methods: We analyzed 203 consecutive patients (134 men and 69 women, mean age 69±14 years) without premorbid disability and a NIHSS score ≤5 at admission [median 3 (IQR 2-4)]. Intravenous thrombolysis was administered within 4.5 hours from stroke onset (n = 119), or it was withheld (n = 84) whenever the treating physician predicted a spontaneous recovery. The baseline risk factors, clinical course, infarction volume, bleeding complications, and functional outcome at 3 months were analyzed and declared to a Web-based registry which was accessible to the local Health Authorities.

Results: Expectedly, not thrombolysed patients had the mildest strokes at admission [median 2 (IQR 1-3.75)]. At day 2 to 5, the infarct volume on DWI-MRI was similar in both groups. There were no symptomatic cerebral bleedings in the study. An ordinal regression model adjusted for baseline stroke severity showed that thrombolysis was associated with a greater proportion of patients who shifted down on the modified Rankin Scale score at 3 months (OR 2.66; 95% CI 1.49-4.74, p = 0.001).

Conclusions: Intravenous thrombolysis seems to be safe in patients with mild stroke and may be associated with improved outcome compared with untreated patients. These results support the evaluation of the efficacy of intravenous thrombolysis in mild stroke patients in randomized clinical trials.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Distribution of modified Rankin Scales scores at 3 months in patients with mild stroke and treated or not with intravenous thrombolytic therapy.

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References

    1. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, et al. (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38: 1655–1711. - PubMed
    1. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25: 457–507. - PubMed
    1. Fonarow GC, Saver JL, Smith EE, Broderick JP, Kleindorfer DO, et al. (2012) Relationship of National Institutes of Health Stroke Scale to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc 1: 42–50. - PMC - PubMed
    1. Dhamoon MS, Moon YP, Paik MC, Boden-Albala B, Rundek T, et al. (2009) Long-term functional recovery after first ischemic stroke: the Northern Manhattan Study. Stroke 40: 2805–2811. - PMC - PubMed
    1. Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM (2001) Why are stroke patients excluded from rtPA therapy? An analysis of patient eligibility. Neurology 56: 1015–1020. - PubMed

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