Very mild stroke patients benefit from intravenous tissue plasminogen activator without increase of intracranial hemorrhage

Abstract

Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) is an effective medication currently used to treat acute ischemic stroke within three hours of symptom onset in patients with an identifiable clinical deficit measured using the National Institute of Health Stroke Scale (NIHSS).

Methods: We compared the outcomes of 27 identified patients with an NIHSS of 6 or less who received IV rt-PA for acute ischemic stroke treatment within three hours of symptom onset in our center with 24 historic controls from the nationally available National Institute of Neurological Disorders and Stroke (NINDS) study database.

Results: The mean initial NIHSS was not significantly different in patients and control groups (mean +/- SD: 4.52 +/- 1.25 and 4.71 +/- 1.4) (P = 0.45). The mean modified Rankin score (mRS) at the time of discharge in patients and control group were 0.78 +/- 1.19 and 1.75 +/- 1.75, respectively. The mRS at discharge demonstrated a statistically significant (P < 0.03) improved clinical outcome for IV rt-PA treated group. The rate of intracranial hemorrhage (ICH) in the IV rt-PA group and control group was not significantly different (P = 1, odds ratio: 0.88, CI: 0.05-14.09).

Conclusion: This retrospective study demonstrates that administering intravenous rt-PA to patients with a very mild stroke (NIHSS of 6 or less) can lead to improved clinical outcome when compared to patients with similar NIHSS who have not received similar treatment.