Antiplatelet therapy versus intravenous thrombolysis for mild acute ischaemic stroke: a living systematic review and meta-analysis

作者：Mingzhen Qin, Tingting Liu, Xinyi Shi, Luda Feng, Tingting Li, Zixin Cheng, Sisong Cheng, Congren Zhou, Mingrun Zou, Qi Jia, Chi Zhang, Ying Gao · 发表于：Stroke and Vascular Neurology · 年份：2024 · DOI：10.1136/svn-2024-003097 · 被引用次数：8 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Antiplatelet Therapy and Cardiovascular Diseases

BACKGROUND: Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis (IVT) for mild acute ischaemic stroke (AIS), with National Institutes of Health Stroke Scale score 0-5. OBJECTIVE: To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild AIS. METHODS: A systematic search of MEDLINE, Embase and Cochrane Library was conducted from database inception until July 2023, without language restriction. Randomised clinical trials (RCTs) or observational studies were selected. The primary outcomes were 90-day functional outcomes, measured by the modified Rankin Scale (mRS) score. The protocol has been registered before data collection. RESULTS: Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analysed (2454 in antiplatelet therapy and 1521 in IVT therapy). There were no significant differences between antiplatelet therapy and IVT in 90-day functional outcomes (mRS 0-1, OR 1.08 (95% CI 0.73 to 1.58); mRS 0-2, OR, 1.04 (95% CI 0.63 to 1.73)), death (OR, 0.64 (95% CI 0.19 to 2.13)) and stroke recurrence (OR, 0.71 (95% CI 0.28 to 1.79)). Antiplatelet therapy was associated with a reduced risk of symptomatic intracranial haemorrhage (sICH) compared with IVT (OR, 0.20 (95% CI 0.06 to 0.69)). CONCLUSIONS: Among patients with mild AIS, compared with IVT, early application of antiplatelet therapy was not significantly associated with i...