Qin Bin, Fu Lin, Qin Huixun, Liang Yuming, Qin Cheng, Zhang Jiede, Gao Wen
Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China.
The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Front Pharmacol. 2024 Jun 10;15:1377475. doi: 10.3389/fphar.2024.1377475. eCollection 2024.
The efficacy of intravenous thrombolysis (IVT) in patients with acute minor ischaemic stroke (AMIS) remains unclear. We performed a meta-analysis to compare the efficacy and safety of IVT and dual antiplatelet therapy (DAPT) in patients with AMIS.
The Embase, Cochrane Library, PubMed, and Web of Science databases were searched up to 10 October, 2023. Prospective and retrospective studies comparing the clinical outcomes of IVT and DAPT were included. Odds ratios (ORs) and 95% confidence intervals (CIs) for early neurological deterioration (END), excellent and favourable functional outcomes, recurrent ischaemic stroke at 3 months, mortality at 3 months, and symptomatic intracranial haemorrhage (ICH) were pooled using a random-effects model.
Of the five included studies, 6,340 patients were included. In patients with AMIS, IVT was not significantly associated with excellent and favourable functional outcomes, recurrent ischaemic stroke, or all-cause mortality at 3 months compared to early DAPT. However, a higher risk of symptomatic ICH (OR, 9.31; 95% CI, 3.39-25.57) and END (OR, 2.75; 95% CI, 1.76-4.30) were observed with IVT.
This meta-analysis indicated that IVT was not superior to DAPT in patients with AMIS, especially in those with nondisabling AIS. However, these findings should be interpreted with caution and have some limitations. Further, well-designed randomised controlled trials are warranted.
急性轻度缺血性卒中（AMIS）患者静脉溶栓（IVT）的疗效仍不明确。我们进行了一项荟萃分析，以比较IVT与双联抗血小板治疗（DAPT）在AMIS患者中的疗效和安全性。
检索截至2023年10月10日的Embase、Cochrane图书馆、PubMed和Web of Science数据库。纳入比较IVT和DAPT临床结局的前瞻性和回顾性研究。使用随机效应模型汇总早期神经功能恶化（END）、良好和有利功能结局、3个月时复发性缺血性卒中、3个月时死亡率以及症状性颅内出血（ICH）的比值比（OR）和95%置信区间（CI）。
纳入的五项研究共纳入6340例患者。在AMIS患者中，与早期DAPT相比，IVT在3个月时与良好和有利功能结局、复发性缺血性卒中和全因死亡率无显著相关性。然而，观察到IVT有更高的症状性ICH风险（OR，9.31；95%CI，3.39 - 25.57）和END风险（OR，2.75；95%CI，1.76 - 4.30）。
这项荟萃分析表明，IVT在AMIS患者中并不优于DAPT，尤其是在非致残性急性缺血性卒中（AIS）患者中。然而，这些发现应谨慎解释且存在一些局限性。此外，有必要进行精心设计的随机对照试验。
