Effect of alteplase versus aspirin plus clopidogrel in acute minor stroke. (1st September 2020)

• Record Type: Journal Article
• Authors: Lan, Lihuan; Rong, Xiaoming; Shen, Qingyu; Gong, Hanxian; Li, Xiangpen; Wang, Hongxuan; Li, Mei; Pan, Jingrui; Zhang, Xiaoni; Peng, Ying
• Is Part Of: International journal of neuroscience. Volume 130:Number 9(2020)
• Page Start: 857
• Page End: 864
• Publication Date: 2020-09-01
• Subjects: Minor stroke -- alteplase -- aspirin -- clopidogrel; Nervous system -- Periodicals; 612.805
• DOI: 10.1080/00207454.2019.1707822
• Languages: English
• ISSNs: 0020-7454

Abstract

Abstract: Background and purpose: The optimal treatment for acute ischemic stroke with mild neurologic deficits is unclear. We aimed to compare the efficacy and safety of alteplase versus dual-antiplatelet therapy in acute minor stroke. Methods: We performed a retrospective cohort study of patients with minor ischemic stroke and National Institutes of Health Stroke Scale scores ≤5 presenting within 24 h from last seen normal. Patients were divided into intravenous alteplase or dual-antiplatelet therapy group. The primary outcome was a modified Rankin Scale (mRS) score of 0 or 1 at 90 days. Secondary outcomes included mRS score at 7 days, and composite outcome of vascular events within 90 days. The safety outcome was any intracranial hemorrhage (ICH) according to the ECASS II criteria. Clinical outcomes were compared using a multivariable logistic regression after adjusting for confounding factors. We then performed the propensity score matching as a sensitivity analysis. Results: Two hundred twenty-eight patients met the eligibility criteria were included for analysis between January 2015 and September 2018. In the aspirin-clopidogrel group, 109 patients (91.6%) achieved a favorable functional outcome at 3-month versus 85(78.0%) in the alteplase group (OR 4.463, 95%CI 1.708–11.662, p = .002). The difference of the composite outcome of vascular events were not statistical significance between the two groups ( p > .05). Asymptomatic ICH occurred in 0.8% patients who received aspirin-clopidogrel, as compared with 3.7% patients in alteplase group ( p = .030). Conclusions: Patients treated with dual-antiplatelet therapy with acute minor ischemic stroke had greater functional outcome at 3 months compared with patients who received alteplase therapy. Classification of evidence: This study provides Class IV evidence that dual-antiplatelet therapy is superior to alteplase for achieving a better functional outcome and does not increase the risk of hemorrhage in acute minor ischemic stroke.