Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Moawad M.H.E.D.; Salem T.; Alaaeldin A.; Elaraby Y.; Awad P.D.; Khalifa A.A.; Naggar A.E.; Mohamed K.A.; Elhalal M.; Badr M.; Abdelnaby R.

Journal: BMC Neurology

Publisher: BioMed Central Ltd

Publication Date: 2025

Volume / Issue: Volume 25 / Issue 1

Article No.: 33

ISSN: 14712377

DOI: 10.1186/s12883-024-04000-8

Scopus: View on Scopus

PubMed: 39844066

Document Type: Review

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Moawad M.H.E.D., Faculty of Medicine, Suez Canal University, Ismailia, Egypt, Alexandria Main University Hospital, Alexandria, Egypt; Salem T., Faculty of Medicine, Masaryk University, Brno, Czech Republic; Alaaeldin A., Faculty of Medicine, Cairo University, Cairo, Egypt; Elaraby Y., Faculty of Medicine, New Giza University, Cairo, Egypt; Awad P.D., Department of Public Health, Theodor Bilharz Research Institute, Cairo, Egypt; Khalifa A.A., Faculty of Medicine, Cairo University, Cairo, Egypt; Naggar A.E., Faculty of Medicine, Cairo University, Cairo, Egypt; Mohamed K.A., Faculty of Medicine, Cairo University, Cairo, Egypt; Elhalal M., Neuroradiology Department, RWTH University Hospital of Aachen, Aachen, Germany; Badr M., Department for Epileptology, Bonn University, Bonn, Germany; Abdelnaby R., Department of Neurology, RWTH Aachen University, Pauwels Street 30, Aachen, 52074, Germany

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. © The Author(s) 2025.

Keywords

Acute ischemic stroke; Efficacy; Intracranial hemorrhage; Safety; Tissue Plasminogen Activator; Administration, Intravenous; Fibrinolytic Agents; Humans; Ischemic Stroke; Stroke; Thrombolytic Therapy; Treatment Outcome; alteplase; tenecteplase; fibrinolytic agent; atrial fibrillation; blood clot lysis; brain hemorrhage; cerebrovascular accident; comorbidity; diabetes mellitus; human; hyperlipidemia; hypertension; intravenous drug administration; meta analysis; mortality rate; National Institutes of Health Stroke Scale; Newcastle-Ottawa scale; Rankin scale; Review; sensitivity analysis; stroke patient; systematic review; drug therapy; fibrinolytic therapy; procedures

Citation Information

Scopus Citations: 12

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