title: Safety and outcome of thrombolysis in mild stroke: a meta-analysis.
abstract: BACKGROUND
  Whether patients presenting with mild stroke should or should not be treated with intravenous rtPA is still controversial. This systematic review aims to assess the safety and outcome of thrombolysis in these patients.
  
  
  METHODS
  We systematically searched PubMed and Cochrane Central Register of Controlled Trials for studies evaluating intravenous rtPA in patients with mild or rapidly improving symptoms except case reports. Excellent outcome (author reported, mainly mRS 0-1), symptomatic intracranial hemorrhage (sICH) and mortality were analyzed.
  
  
  RESULTS
  Fourteen studies were included (n=1906 patients). Of these, 4 studies were comparative (2 randomized and 2 non-randomized). The remaining were single-arm studies. On the basis of 4 comparative studies with a total of 1006 patients, the meta-analysis did not identify a significant difference in the odds of excellent outcome (OR=0.86; 95% CI: 0.64-1.15; I2=0) between IV rtPA-treated minor stroke and those without rtPA treatment. Eleven studies involving 1083 patients showed the pooled rate of excellent outcome was 76.1% (95% CI: 69.8-81.5%, I2=42.5). Seven studies involving 378 patients showed the mortality rate was 4.5% (95% CI: 2.6-7.5%, I2=1.4). Twelve studies involving 831 patients showed the pooled rate of sICH was 2.4% (95% CI: 1.5-3.8, I2=0).
  
  
  CONCLUSIONS
  Although efficacy is not clearly established, this study reveals the adverse event rates related to thrombolysis are low in mild stroke. Intravenous rtPA should be considered in these patients until more RCT evidence is available.
authors.affiliation: Department of Neurology, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Lei
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Hengfang
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Bo
authors.initials: B
authors.lastname: Song
authors.affiliation: Department of Neurology, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Changdong
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Dandan
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Neurology, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland).
authors.forename: Yuming
authors.initials: Y
authors.lastname: Xu
mesh_terms: D006801:Humans; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy