关键词: 静脉溶栓, 双联抗血小板治疗, 急性轻型非致残性缺血性脑卒中, 预后

Abstract: Objective  To explore the clinical efficacy and safety of intravenous thrombolysis and dual antiplatelet therapy in the treatment of acute mild non-disabling ischemic stroke.  Methods  A retrospective cohort study was conducted, including 138 patients with acute mild non-disabling ischemic stroke［National Institutes of Health Stroke Scale（NIHSS） score≤5］from January 2022 to March 2024, within 6 h of onset. Patients were divided into an intravenous thrombolysis group (66 cases) and a dual antiplatelet group (72 cases). Propensity score matching was used to match patients 1∶1, resulting in 44 patients in each group after matching. Demographic data, clinical data, clinical outcome indicators, and adverse events were collected. The primary outcome was defined as a good functional outcome［modified Rankin Scale(mRS) score 0－2］ at 90 d post-onset. Secondary outcomes included NIHSS scores at 24 h, 72 h, and 7 d post-onset; the proportion of early neurological deterioration; intracranial and systemic hemorrhagic events within 90 d post-onset; and death within 90 d. Results  ①Before matching, the intravenous thrombolysis group had a lower age and admission mRS score than that of the dual antiplatelet group, with statistically significant differences (all P<0.05). After matching, there were no statistically significant differences between the two groups in terms of age, gender, hypertension, diabetes, cardiac disease, atrial fibrillation, hyper low density lipoprotein -cholesterol (LDL-C), hyperhomocysteinemia, prior stroke, prior smoking, admission NIHSS score, admission mRS score, location of stroke and TOAST classification (all P>0.05); ②There was no statistically significant difference in the proportion of patients with a good functional outcome at 90 d post-onset and the mRS score at 90 d between the intravenous thrombolysis group and the dual antiplatelet group［88.6% (39/44) vs 93.2% (41/44), P=0.458, P=0.308］; ③ The intravenous thrombolysis group had significantly lower median NIHSS scores at 24 h and 72 h post-onset compared to the dual antiplatelet group, with statistically significant differences［1 vs  2.5, 1 vs  2, P=0.018, 0.043］. There were no statistically significant differences in the other efficacy and safety outcomes. Conclusions Intravenous thrombolysis therapy can bring significant short-term benefits to patients with acute mild non-disabling ischemic stroke, helping to shorten the time to recovery to a good neurological functional outcome, and does not increase the risk of bleeding and mortality. However, in terms of good functional outcomes at 90 d post-onset, its effects are similar to those of dual antiplatelet therapy. Nevertheless, there is an urgent need for larger sample, higher quality clinical studies to further validate these findings.

Key words: intravenous thrombolysis, dual antiplatelet therapy, acute mild non-disabling ischemic stroke, prognosis