Original ArticleIntravenous Tissue Plasminogen Activator for Patients with Minor Ischemic Stroke
Section snippets
Methods
Between January 2005 and June 2010, we selected patients from a prospective stroke database who presented to the emergency department within 3 hours from stroke onset and had an admission NIHSS score ≤5. Patients were divided into 2 groups: (1) patients treated with IV t-PA and (2) patients not given any thrombolytic therapy. Patients treated with intraarterial t-PA or other experimental therapies were excluded. All patients received modified Rankin scale (mRS) and Barthel index (BI) scores 90
Results
We identified 133 patients with MIS; from them, 59 patients received IV t-PA and 74 did not receive any thrombolytic therapy (untreated group). Baseline characteristics (age, gender, race, hypertension, atrial fibrillation, diabetes, tobacco use, and prestroke mRS score) were well matched between both groups, with the exception of the initial NIHSS score (mean ± standard deviation [SD], median, Q1, Q3: IV t-PA group 3.4 ± 1.4, 4, 2.5, 5; untreated group 1.9 ± 1.3, 2, 1, 2; P < .0001 [Table 1]).
Discussion
This study reveals no difference in clinical and safety outcomes between MIS patients treated with or without IV t-PA. The rate of SICH, although not registered in the untreated group, was within the expected range and did not alter the rates of mortality or disability in the treated group. However, because higher NIHSS scores predict a higher rate of SICH, and because few previous studies of minor stroke patients treated with IV t-PA have shown a SICH rate between 0% and 2%,8, 9 it could be
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Supported by National Institutes of Health educational grant to UCSD Stroke Center.