Evidence map›Paper›PMID 39844066›Full record

SynthesisBMC neurology2025

Safety and efficacy of intravenous thrombolysis: a systematic review and meta-analysis of 93,057 minor stroke patients.

Mostafa Hossam El Din Moawad, Talal Salem, Anas Alaaeldin, Youssef Elaraby, Peter D Awad, Amr Ahmed Khalifa, Ahmed El Naggar, Khaled Ashraf Mohamed, Mohamed Elhalal, Mostafa Badr and 1 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Mostafa Hossam El Din MoawadFaculty of Medicine, Suez Canal University, Ismailia, Egypt.
Talal SalemFaculty of Medicine, Masaryk University, Brno, Czech Republic.
Anas AlaaeldinFaculty of Medicine, Cairo University, Cairo, Egypt.
Youssef ElarabyFaculty of Medicine, New Giza University, Cairo, Egypt.
Peter D AwadDepartment of Public Health, Theodor Bilharz Research Institute, Cairo, Egypt.
Amr Ahmed KhalifaFaculty of Medicine, Cairo University, Cairo, Egypt.
Ahmed El NaggarFaculty of Medicine, Cairo University, Cairo, Egypt.
Khaled Ashraf MohamedFaculty of Medicine, Cairo University, Cairo, Egypt.
Mohamed ElhalalNeuroradiology Department, RWTH University Hospital of Aachen, Aachen, Germany.
Mostafa BadrDepartment for Epileptology, Bonn University, Bonn, Germany.
Ramy AbdelnabyDepartment of Neurology, RWTH Aachen University, Pauwels Street 30, Aachen, 52074, Germany. Rabdelnaby@ukaachen.de.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe definition of minor ischemic stroke (MIS) is a topic of debate, however, the most accepted definition is a stroke with National Institutes of Health Stroke Scale (NIHSS) ≤ 5. Intravenous thrombolysis (IVT) is a crucial treatment option for acute ischemic stroke (AIS) including: alteplase, recombinant human tissue-type plasminogen activator (r-tPA), and the recently approved tenecteplase. However, there is a debate regarding its safety and efficacy. Therefore, our objective was to determine the safety and efficacy of IVT in treating minor stroke patients (NIHSS ≤ 5).

methodsUsing the search strategy assigned which was based on three keywords: "mild" or "minor", "stroke", and "intravenous thrombolysis", we searched for eligible articles on PubMed, Web of Science, Embase, and Scopus from inception till 10th January 2024. We conducted this meta-analysis using the random effect model to account for the heterogeneity among the studies. For the dichotomous variables, we calculated the odds ratio (OR) from the event and total of these variables. While for the continuous variables, we calculated the mean difference (MD) of these variables. Pooling of OR for the occurrence of events was also conducted.

resultsA total of 21 articles with 93,057 patients with MIS were included. The mean age of the participants ranged from 62.3 to 79.6. Most of the included patients had comorbidities such as hypertension, diabetes, previous stroke, smoking, atrial fibrillation, and hyperlipidemia. Of these, 10,850 received IVT while 82,207 did not. The use of IVT was statistically significant associated with 90-day modified Rankin score (mRs) 0-1 when compared with control with OR of 1.67 (95%CI: 1.46, 1.91, p < 0.00001) and was statistically significantly associated with improvement of NIHSS on discharge with OR of 2.19 (95%CI: 1.56, 3.08, p < 0.00001). In terms of safety outcomes, IVT has proven a safe profile, as there was no significant difference in intracranial hemorrhage (ICH) and mortality rates between the IVT and control groups with OR of 1.75 (95CI: 0.95, 3.23, p = 0.07) and 0.93 (95%CI: 0.77, 1.11, p = 0.41), respectively.

conclusionAlthough some studies have not found any benefits of IVT in MIS patients, a substantial body of literature strongly endorses IVT as an effective and safe treatment for MIS. IVT has been shown to improve the mRs and NIHSS scores at the 90-day mark without an increased risk of ICH or mortality.

Indexed as

Fibrinolytic AgentsIschemic StrokeStrokeThrombolytic TherapyTissue Plasminogen ActivatorAdministration, IntravenousHumansTreatment OutcomeFibrinolytic AgentsTissue Plasminogen ActivatorAcute ischemic strokeEfficacyIntracranial hemorrhageSafetyTissue Plasminogen Activator

Identifiers

PMID39844066
PMCPMC11752810

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.