Intravenous thrombolysis in stroke with admission NIHSS score 0 or 1

 So we still know nothing about treating mild strokes and until we do your doctors will just assume you are too good to treat and let your neurons die. The job of your doctor is to prevent disability not just stand by watching neurons die.  Contact researchers and get appropriate research going. Not doing so is an indictment of the complete stroke hospital starting at the top with the board of directors.

Intravenous thrombolysis in stroke with admission NIHSS score 0 or 1

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Marek Sykora, Stefan Krebs, Florentina Simader, ...

First Published February 10, 2021 Research Article 

https://doi.org/10.1177/1747493021991969

Article information

 

Abstract

Background

Up to 30% of stroke patients initially presenting with non-disabling or mild deficits may experience poor functional outcome. Despite, intravenous thrombolysis remains controversial in this subgroup of stroke patients due to its uncertain risk benefit ratio.

Aim

We aimed to analyze the real-world experience with intravenous thrombolysis in stroke patients presenting with very low NIHSS.

Methods

Data of stroke patients presenting with mild initial stroke severity (NIHSS 0–5) including vascular risk factors, stroke syndrome and etiology, early neurological deterioration, symptomatic intracerebral haemorrhage (sICH), and functional outcome by modified Rankin Scale were extracted from a large nationwide stroke registry and analysed. Patients were categorized and compared according to admission severity NIHSS 0–1 versus NIHSS 2–5 and intravenous thrombolysis use.

Results

Seven hundred and three (2%) of 35,113 patients presenting with NIHSS 0–1 and 6316 (13.9%) of 45,521 of patients presenting with NIHSS 2–5 underwent intravenous thrombolysis. In the NIHSS 0–1 group, intravenous thrombolysis was associated with early neurological deterioration (adjusted OR 8.84, CI 6.61–11.83), sICH (adjusted OR 9.32, CI 4.53–19.15) and lower rate of excellent outcome (mRS 0–1) at three months (adjusted OR 0.67, CI 0.5–0.9). In stroke patients with NIHSS 2–5, intravenous thrombolysis was associated with early neurological deterioration (adjusted OR 1.7, 1.47–1.98), sICH (adjusted OR 5.75, CI 4.45–7.45), and higher rate of excellent outcome (mRS 0–1) at three months (adjusted OR 1.21, CI 1.08–1.34).

Conclusions

Among patients with NIHSS 0–1, intravenous thrombolysis did not increase the likelihood of excellent outcome. Moreover, potential signals of harm were observed. Further research seems to be warranted.

Keywords Low NIHSS, mild, minor, stroke, thrombolysis, harm, safety, efficacy, outcome

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