Mild Stroke Outcomes Improved With TPA


KISSIMMEE, FLA. — Mild stroke symptoms should not preclude thrombolytic therapy in eligible patients, Dr. Nicole R. Gonzales said at the 31st International Stroke Conference.

Patients with mild acute ischemic stroke are often excluded from thrombolytic therapy despite presenting within the 3-hour window for recombinant tissue plasminogen activator (r-TPA) treatment, because it is assumed they will do well without the therapy.

However, in a large prospective study, administration of r-TPA to patients with mild stroke improved their chances of an excellent outcome and appeared to reduce the risk of death, said Dr. Gonzales of the University of Texas, Houston.

Of 885 patients presenting with acute ischemic stroke over a 14-month period, 238 had a National Institutes of Health Stroke Scale (NIHSS) score of between 1 and 7, indicating minimal symptoms (103 patients) or mild symptoms (135 patients).

Overall, 41 patients were treated with r-TPA. Of 46 who arrived within the 3-hour treatment window, 72% were excluded due to mild symptoms.

Outcome at discharge was excellent in 59% of all stroke patients who were treated, regardless of the severity of the stroke, compared with 44% of those not treated.

Of those with minimal stroke symptoms according to the NIHSS score, 90% of those treated had an excellent outcome. The differences were statistically significant, compared with only 58% of those not treated.

Nearly 50% of those with mild symptoms according to the NIHSS score who were treated, compared with 32% who were not treated, also had an excellent outcome, however the numbers in this group were too small to show statistical significance.

None of the treated patients with minor or mild symptoms died, while two in the untreated group died, although these numbers were also too small to show statistical significance.

“The findings argue strongly against exclusion of patients from thrombolytic therapy based on minimal or mild symptoms,” Dr. Gonzales said.

The conference was sponsored by the American Stroke Association.

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