Clinical and paraclinical characteristics and treatment outcomes of patients with minor stroke admitted within the first 4.5 hours

Tóm tắt

The optimal therapeutic approach for patients with minor stroke presenting within 4.5 hours of symptom onset remains a subject of ongoing debate, particularly regarding the efficacy and safety of intravenous thrombolysis with alteplase compared to single (SAPT) or dual antiplatelet therapy (DAPT). We conducted a single-center, observational cohort study involving patients with acute minor stroke (NIHSS ≤ 5) who were admitted within 4.5 hours to the Stroke Center of Bach Mai Hospital. Patients were stratified into three treatment groups: intravenous alteplase, DAPT, and SAPT. The primary outcome was a favorable functional incidence at 90 days, defined as a modified Rankin Scale (mRS) score of 0–1. The results show that among 186 patients (34 alteplase, 119 DAPT, 33 SAPT), the proportions achieving mRS 0–1 at day 90 were 90.4% (79.4%, 96.7%, and 78.8%, respectively). The alteplase group demonstrated a higher baseline NIHSS score (median 4 [IQR: 3.75 – 5]) than the DAPT and SAPT groups (both with a median of 2; p < 0.001). Early neurological deterioration (END) occurred in 38.2% of the alteplase group, 18.2% of the SAPT group, and 0.8% of the DAPT group. END was an associated factor with unfavorable outcomes (mRS 2–6), with an adjusted odds ratio of 2.14 (95% CI: 1.25 – 3.68; p < 0.01). In this single-center observational study, 90.4% of patients with minor stroke achieved favorable functional outcomes at 90th day. The rates of favorable outcomes in the DAPT, alteplase, and SAPT groups were 96.7%, 79.4%, and 78.8%, respectively. Patients treated with alteplase had higher baseline NIHSS scores and a greater frequency of early neurological deterioration, which was associated with poor functional outcomes at 90 days.