Safety And Efficacy Of Intravenous Thrombolysis With Alteplase In Mild Stroke:a Meta-analysis

Generally,Mild stroke refers to stroke symptoms with mild or rapid improvement of symptoms,and its definition has not been unified,which can be any score of NIHSS≤3;NIHSS≤5;and MRS≤3。Intravenous thrombolysis with alteplase is one of the most effective treatments for acute ischemic stroke and has been recommended by guidelines in China and many countries.Among them,patients with mild ischemic stroke may miss the best time for treatment due to mild or rapid improvement of symptoms,and these patients have the characteristics of high risk of early stroke recurrence and disability,which should be paid attention to by the population.Chinese guidelines state that intravenous thrombolytic therapy can be considered in stroke patients with mild non-disabling stroke and rapid improvement of symptoms under the premise of adequate evaluation,so the therapeutic effect of active thrombolysis in patients with mild ischemic stroke has not been clarified.In this study,we evaluated the safety and efficacy of alteplase given after the onset of mild ischemic stroke symptoms by meta-analysisObjective:To evaluate the safety and efficacy of alteplase in the treatment of mild ischemic stroke by long-term prognosis,mortality and bleeding events,in order to provide a stronger evidence-based basis for the treatment of patients with mild ischemic strokeMethods:The databases of China National Knowledge Infrastructure,VIP Chinese journals,Wanfang,CBM,Pubmed,Cochrane Library、embase and web of science were searched to find the clinical controlled study or randomized controlled study on the therapeutic effect of intravenous thrombolysis with alteplase on mild stroke.The Chinese and English literatures were searched according to the combination of subject terms and free words from database establishment to November 2020.The quality of literatures meeting the criteria(such as Newcastle-Ottawa Scale)was evaluated,the literature data were extracted,and the prognostic outcomes,mortality,bleeding events and other indicators were statistically analyzed with RevMan5.3 software to assess the therapeutic effect of alteplaseResults:A total of 12 articles with a total of 3190 cases were included,including 1473 in the intervention group and 1717 in the control group.The results showed:in terms of safety:the bleeding events in the thrombolysis group were higher than those in the control group,and the difference had statistical significance(OR=3.49,95%CI:2.13～5.71,P<0.05);compared with the non-thrombolysis group,the thrombolysis group did not increase the mortality,and the difference had no statistical significance(OR=1.05,95%CI:0.42～2.62,P=0.91).Efficacy results showed that the 90-day prognostic outcome of the thrombolysis group was better than that of the non-thrombolysis group,with statistical significance(OR=1.53,95%CI:1.02～2.30,P<0.05).Conclusion:1.Intravenous thrombolysis in patients with MIS may increase their risk of bleeding,but does not increase their mortality.2.The 90-day prognostic outcome of patients treated with rt-PA is better than that of the antiplatelet therapy group,which may improve their long-term prognosis.3.For patients with different stroke etiologies,large artery atherosclerotic types can benefit from rt-PA treatment.