Medical management versus intravenous thrombolysis for patients with minor non-disabling acute ischemic stroke: A systematic review and meta-analysis

Abstract

Background: The efficacy and safety of thrombolysis therapy in patients with mild stroke, especially acute non-disabling stroke is controversial. We intend to conduct this systematic review and meta- analysis to evaluate the efficacy and safety of thrombolytic therapy compared to medical management in acute non-disabling stroke.

Methods: We searched multiple databases to obtain articles related to medical management and intravenous thrombolysis therapy for minor non-disabling acute ischemic stroke from inception until November 28, 2023, and the search was conducted again on September 1, 2024. The primary outcome was functional independence (modified Rankin scale [mRS] score of 0 to 2) at 90 days. All analyses were performed using the random effect model. The quality of articles was evaluated through the Cochrane risk assessment tool and Newcastle-Ottawa scale.

Results: 2 RCTs and 7 cohort studies met the inclusion criteria. The merge analysis showed that there was no significant difference in improving functional independence (mRS 0-2, RR: 1.01, 95% CI 0.98 - 1.04, P = 0.47) and excellent outcome (mRS 0-1) of patients with minor non-disabling acute ischemic stroke between IVT and medical management. However, IVT would increase the risk of early neurological deterioration (RR: 0.50, 95% CI 0.30 - 0.82, P = 0.007), compared to medical management. Analysis of the cohort studies showed that there was a significant correlation between IVT and sICH (RR: 0.20, 95% CI: 0.06 - 0.68, P=0.01).

Conclusions: For patients with minor non-disabling acute ischemic stroke, medical management will not have a negative impact on functional recovery, and may be a safer alternative.