Abstract Body: Background: Previous study found that compared with thrombolysis, antiplatelet did not improve outcomes but reduce the risk of symptomatic intracranial hemorrhage(sICH) for mild acute ischemic stroke(AIS) defined as National Institutes of Health Stroke Scale score 0 to 5. As relevant studies have been released recently, the benefits and risks of the two treatments are still unclear based on latest evidences.
Objective: To compare the efficacy/effectiveness and safety of antiplatelet with thrombolysis for mild AIS in the first update of a living systematic review and meta-analysis.
Methods: MEDLINE, Embase and Cochrane Library were systematically searched from July 2023 until August 2024. Randomized clinical trials(RCTs) and observational studies were selected and checked eligibility for inclusion based on the same criteria as before. The primary outcome was 90-day functional outcome measured by the modified Rankin Scale(mRS). Data extraction and certainty of evidence assessment were conducted in duplicate. This study was registered in the PROSPERO.
Results: Since July 2023, two new studies were added, for a total of three RCTs and five observational studies with 5526 patients(3333 treated with antiplatelet and 2193 treated with thrombolysis). There were no significant differences between antiplatelet and thrombolysis in 90-day functional outcome(mRS 0-1, odds ratio, 0.96 [95% CI, 0.68 to 1.35]; mRS 0-2, odds ratio, 1.06 [95% CI, 0.73 to 1.51]), and stroke recurrence(odds ratio, 1.19 [95% CI, 0.73 to 1.93]). Compared with thrombolysis, antiplatelet was significantly associated with reduced risks on death(odds ratio, 0.36 [95% CI, 0.18 to 0.71]), and sICH(odds ratio, 0.21 [95% CI, 0.08 to 0.56]).
Conclusions: In patients with mild AIS, antiplatelet was similar in functional outcomes and stroke recurrence against thrombolysis, but reduced the risks of death and sICH. Thrombolysis should be used with caution in such patients in clinical practice.