Abstract 1158: Antiplatelet Therapy Versus Intravenous Thrombolysis For Mild Nondisabling Acute Ischemic Stroke: A Living Systematic Review And Meta-analysis

Abstract

Background: Previous studies have shown contradictory results between early application of antiplatelet therapy and intravenous thrombolysis (IVT) for mild nondisabling (defined as NIHSS score of 0 to 5) acute ischemic stroke (AIS). Objective: To compare the benefits and risks of antiplatelet therapy and IVT in patients with mild nondisabling AIS. Methods: A systematic search of MEDLINE, Embase, and Cochrane Library was conducted from database inception until July 26, 2023, without language restriction. Randomized 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 (PROSPERO CRD42023447862). Results: Two RCTs and four observational studies with relatively low risk of bias that enrolled 3975 patients were analyzed (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, odds ratio [OR], 1.08 [95% CI, 0.73-1.58]; mRS 0-2, OR, 1.04 [95% CI, 0.63-1.73]), death (OR, 0.64 [95% CI, 0.19-2.13]), and stroke recurrence (OR, 0.71 [95% CI, 0.28-1.79]). Antiplatelet therapy was associated with a reduced risk of sICH compared with IVT (OR, 0.20 [95% CI, 0.06-0.69]). Conclusions: Among patients with mild nondisabling AIS, compared with IVT, early application of antiplatelet therapy was not significantly associated with improved functional outcomes, reduced mortality, or stroke recurrence, but was significantly associated with a reduced risk of sICH. Regular updates will provide the best available evidence as new researches are published.