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Meta-Analysis
. 2025 Apr 29;10(2):e003097.
doi: 10.1136/svn-2024-003097.

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

Mingzhen Qin  1 , Tingting Liu  2 , Xinyi Shi  1 , Luda Feng  3 , Tingting Li  1 , Zixin Cheng  1 , Sisong Cheng  1 , Congren Zhou  1 , Mingrun Zou  1 , Qi Jia  1 , Chi Zhang  4 , Ying Gao  4   5
Affiliations
Meta-Analysis

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

Mingzhen Qin et al. Stroke Vasc Neurol. .

Abstract

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 improved functional outcomes, reduced death or stroke recurrence, but was significantly associated with a reduced risk of sICH.

Prospero registration number: CRD42023447862.

Keywords: Stroke; Thrombolysis; Thrombolytic Therapy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Flow diagram.
Figure 2
Figure 2. Forest plot of antiplatelet therapy versus IVT on excellent functional outcome at 90 days. IVT, intravenous thrombolysis; RCT, randomised clinical trial; M-H, Mantel-Haenszel.
Figure 3
Figure 3. Forest plot of antiplatelet therapy versus IVT on death within 90 days. IVT, intravenous thrombolysis; RCT, randomised clinical trial; M-H, Mantel-Haenszel.
Figure 4
Figure 4. Forest plot of antiplatelet therapy versus IVT on sICH within 90 days. IVT, intravenous thrombolysis; RCT, randomised clinical trial; sICH, symptomatic intracranial haemorrhage; M-H, Mantel-Haenszel.
See this image and copyright information in PMC

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