title: Comparative effectiveness of standard care with IV thrombolysis versus without IV thrombolysis for mild ischemic stroke.
abstract: BACKGROUND
  One third of patients presenting with initially mild strokes have unfavorable outcomes, and the efficacy of intravenous thrombolysis (IVT) in this population has not been proven. This study aimed to evaluate the comparative effectiveness of standard care with IVT versus without IVT in mild stroke patients.
  
  
  RESULTS
  Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial National Institutes of Health Stroke Scale scores ≤5. Multivariable logistic analysis and propensity score matching were used to adjust for baseline imbalances between the patients who did and did not receive IVT. Adjusted odds ratios and 95% CIs of IVT were estimated for 3-month modified Rankin Scale scores of 0 to 1 and symptomatic. Of 13 117 patients with stroke who were hospitalized between April 2008 and May 2012, 1386 met the eligibility criteria, and 194 (14.0%) were treated with IVT. For a modified Rankin Scale of 0 to 1 at 3 months, the adjusted odds ratios were 1.96 (95% CI, 1.28 to 3.00; P=0.002) by multivariable logistic analysis and 1.68 (1.10 to 2.56; P=0.02) by propensity score matching analysis, respectively. There was a statistically nonsignificant excess of symptomatic hemorrhagic transformation (odds ratios=3.76 [0.95 to 16.42; P=0.06] and 4.81 [0.84 to 49.34; P=0.09]), respectively.
  
  
  CONCLUSIONS
  In this observational registry-based study, standard care with IVT is more effective than not receiving IVT in mildischemic stroke patients, and there is a statistically nonsignificant risk of symptomatic hemorrhagic transformation.
authors: Jay Chol
authors: JC
authors: Choi
authors: Min Uk
authors: MU
authors: Jang
authors: Kyusik
authors: K
authors: Kang
authors: Jong-Moo
authors: JM
authors: Park
authors: Youngchai
authors: Y
authors: Ko
authors: Soo-Joo
authors: SJ
authors: Lee
authors: Jae-Kwan
authors: JK
authors: Cha
authors: Dae-Hyun
authors: DH
authors: Kim
authors: Sang Soon
authors: SS
authors: Park
authors: Tai Hwan
authors: TH
authors: Park
authors: Kyung Bok
authors: KB
authors: Lee
authors: Jun
authors: J
authors: Lee
authors: Joon-Tae
authors: JT
authors: Kim
authors: Ki-Hyun
authors: KH
authors: Cho
authors: Kyung-Ho
authors: KH
authors: Yu
authors: Mi-Sun
authors: MS
authors: Oh
authors: Byung-Chul
authors: BC
authors: Lee
authors: Yong-Jin
authors: YJ
authors: Cho
authors: Dong-Eog
authors: DE
authors: Kim
authors: Ji Sung
authors: JS
authors: Lee
authors: Juneyoung
authors: J
authors: Lee
authors: Philip B
authors: PB
authors: Gorelick
authors: Hee-Joon
authors: HJ
authors: Bae
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
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