Efficacy And Safety Of Intravenous Thrombolysis In Patients With Minor Stroke

Objietive: The study was designed to vertify the efficacy and safety of intravenous thrombolysis in patients with minor stroke within 4.5 hour time window.Methods: Two hundred and seventy one patients with minor stroke admitted to the first affiliated hospital or the second affiliated hospital from August 2016 to November 2017 were included,they all arrived at the hospital within 4.5 hours after onset.Minor stroke was defined as the National Institutes of Health Stroke Scale(NIHSS)score ?5 at admission.The patients in the thrombolytic group were treated with intravenous thrombolysis,and then given antiplatelets if CT excludes bleeding after 24 hours.The patients in the control group were given the antiplatelets after admitted to the hospital.Baseline data are comparable between the two groups.Safety: the proportion of symptomatic intracranial hemorrhage after treatment in 7d.Short-term efficacy: NIHSS scores at 24 h and on 7d after treatment reduced by ?18% from baseline was defined as effective treatment;NIHSS scores at 24 h and on 7d after treatment decreased by ? 4 points from baseline or neurological deficits disappeared completely was defined as significantly symptoms improved.Prognosis : The prognosis of patients was evaluated by three-month modified Rankin Scale,the favorable outcome was defined as mRS 0~1,the unfavorable outcome was defined as mRS 2~6.Results: 1.Safety: 10 cases of intracranial hemorrhage occurred in the thrombolytic group,the incidence was 6.58%(10/152),2 cases of intracranial hemorrhage occurred in the control group,the incidence was 1.68%(2/119),the difference was not statistically significant(P=0.0728).2 cases of symptomatic intracranial hemorrhage occurred in the thrombolytic group,the incidence was 1.32%(10/152),there was no symptomatic intracranial hemorrhage occurred in the control group,the difference was not statistically significant P=0.5056).2.Short-term efficacy:(1)The effective rate after treatment at 24 hours was 59.21%(90/152)in thrombolytic group and 8.40%(10/119)in the control group,the difference was statistically significant(P<0.0001);the effective rate after treatment on 7 days was 67.76%(103/152)in thrombolytic group and 42.02%(50/119)in the control group,the difference was statistically significant(P<0.0001).(2)The proportion of significantly symptoms improved at 24 hours after treatment was 20.39%(31/152)in the thrombolytic group and 0.84%(1/119)in the control group,the difference was statistically significant(P<0.0001);the proportion of significantly improved symptoms on 7days after treatment was 35.53%(54/152)in the thrombolytic group and 14.29%(17/119)in the control group,the difference was statistically significant(P<0.0001).3.Prognosis: the proportion of favorable outcome in thrombolytic group was 77.63%(118/152),the proportion was 65.55%(78/119)in the control group,the difference was statistically significant(P=0.0294).Conclusions: 1.Intravenous thrombolysis for minor stroke does not increase the risk of symptomatic intracranial hemorrhage;2.Intravenous thrombolysis for minor stroke can increase the rate of short-term effective treatment and significantly symptoms improved,and reduce the neurological disability at 3 months.