Neurology® Journal Club: Meta-Analysis of Randomized Controlled Trials on IV Thrombolysis in Patients With Minor Acute Ischemic Stroke.

Abstract (English)

Drawing exclusively from randomized controlled trials (RCTs), the meta-analysis by Doheim et al. evaluates the comparative effectiveness of intravenous thrombolysis (IVT) vs nonthrombolytic standard of care (NT-SC) in patients with minor acute ischemic stroke (AIS). The authors identified 9 reports encompassing 13 RCTs. Multiple analytical approaches (Q and <i>I</i>² measures, leave-out-one analyses, sensitivity analyses) were performed to address study heterogeneity. Findings show that, compared with NT-SC, IVT was not significantly associated with excellent functional recovery poststroke (odds ratio 0.85, 95% CI 0.70-1.03). IVT was associated with lower odds of achieving functional independence and higher odds of symptomatic intracranial hemorrhage and mortality at 90 days. A major strength is the study's exclusive inclusion of RCTs, which minimizes methodological heterogeneity and enhances internal validity. Limitations include (1) small number of included studies precluding formal assessment of publication bias; (2) exclusion of observational or quasiexperimental studies, potentially overlooking valuable real-world evidence; (3) variability in the definition of minor AIS; and (4) insensitivity of conventional outcome measures such as the modified Rankin Scale to capture nonmotor functional deficits such as fatigue and return-to-work capability, which are highly relevant to patients with minor stroke but remain underrepresented in traditional assessments. In conclusion, this meta-analysis suggests that IVT does not confer additional benefit over NT-SC for minor nondisabling stroke. Future studies would benefit from incorporating broader, patient-centered functional outcomes to better capture the subtleties of disability in this patient population.