title: The outcome of patients with mild stroke improves after treatment with systemic thrombolysis.
abstract: BACKGROUND
  In up to one third of patients with mild stroke suitable to receive systemic thrombolysis the treatment is not administered because the treating physicians estimate a good spontaneous recovery. However, it is not settled whether the fate of these patients is equivalent to those who are thrombolysed.
  
  
  METHODS
  We analyzed 203 consecutive patients (134 men and 69 women, mean age 69±14 years) without premorbid disability and a NIHSS score ≤5 at admission [median 3 (IQR 2-4)]. Intravenous thrombolysis was administered within 4.5 hours from stroke onset (n = 119), or it was withheld (n = 84) whenever the treating physician predicted a spontaneous recovery. The baseline risk factors, clinical course, infarction volume, bleeding complications, and functional outcome at 3 months were analyzed and declared to a Web-based registry which was accessible to the local Health Authorities.
  
  
  RESULTS
  Expectedly, not thrombolysed patients had the mildest strokes at admission [median 2 (IQR 1-3.75)]. At day 2 to 5, the infarct volume on DWI-MRI was similar in both groups. There were no symptomatic cerebral bleedings in the study. An ordinal regression model adjusted for baseline stroke severity showed that thrombolysis was associated with a greater proportion of patients who shifted down on the modified Rankin Scale score at 3 months (OR 2.66; 95% CI 1.49-4.74, p = 0.001).
  
  
  CONCLUSIONS
  Intravenous thrombolysis seems to be safe in patients with mild stroke and may be associated with improved outcome compared with untreated patients. These results support the evaluation of the efficacy of intravenous thrombolysis in mild stroke patients in randomized clinical trials.
authors.affiliation: Functional Unit of Cerebrovascular Diseases, Hospital Clínic, Barcelona, Spain.
authors.forename: Xabier
authors.initials: X
authors.lastname: Urra
authors.forename: Helena
authors.initials: H
authors.lastname: Ariño
authors.forename: Laura
authors.initials: L
authors.lastname: Llull
authors.forename: Sergio
authors.initials: S
authors.lastname: Amaro
authors.forename: Víctor
authors.initials: V
authors.lastname: Obach
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Cervera
authors.forename: Ángel
authors.initials: Á
authors.lastname: Chamorro
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator