Open AccessComparative Effectiveness of Standard Care With IV Thrombolysis Versus Without IV Thrombolysis for Mild Ischemic Stroke
Author(s) -
Choi Jay Chol,
Jang Min Uk,
Kang Kyusik,
Park JongMoo,
Ko Youngchai,
Lee SooJoo,
Cha JaeKwan,
Kim DaeHyun,
Park Sang Soon,
Park Tai Hwan,
Lee Kyung Bok,
Lee Jun,
Kim JoonTae,
Cho KiHyun,
Yu KyungHo,
Oh MiSun,
Lee ByungChul,
Cho YongJin,
Kim DongEog,
Lee Ji Sung,
Lee Juneyoung,
Gorelick Philip B.,
Bae HeeJoon
Publication year - 2015
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.114.001306
Subject(s) - medicine , thrombolysis , modified rankin scale , propensity score matching , odds ratio , stroke (engine) , observational study , logistic regression , population , ischemic stroke , myocardial infarction , ischemia , mechanical engineering , environmental health , engineering
Background One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis ( IVT ) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients. Methods and Results Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT . Adjusted odds ratios and 95% CI s of IVT were estimated for 3‐month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0%) were treated with IVT . For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95% CI , 1.28 to 3.00; P =0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P =0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P =0.06] and 4.81 [0.84 to 49.34; P =0.09]), respectively. Conclusions In this observational registry‐based study, standard care with IVT is more effective than not receiving IVT in mild ischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.