ผลการรักษาและความปลอดภัยของการใช้ rtPA ทางหลอดเลือดดำสำหรับ Minor Ischemic Stroke: ประสบการณ์จากโรงพยาบาลอุดรธานี

Chaiwat  Klinhom-on

Authors

Chaiwat Klinhom-on Department of Medicine, Udonthani Hospital

Keywords:

Thrombolysis, Ischemic Stroke, Minor Stroke, Alteplase, Symptomatic Intracranial Hemorrhage

Abstract

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) is an effective treatment for acute ischemic stroke. However, its use in minor stroke (NIHSS < 4) remains controversial. This study aimed to evaluate the functional outcomes and safety of rtPA in minor stroke patients compared with non-rtPA treatment. To compare functional outcomes assessed by the Modified Rankin Scale (mRS) at 3 and 6 months and to determine the incidence of symptomatic intracranial hemorrhage within 6 months. A retrospective cohort study was conducted among patients with acute minor ischemic stroke (NIHSS < 4) treated at Udonthani Hospital between January and December 2024. Patients were divided into rtPA and non-rtPA groups. Statistical analysis was performed using chi-square and multivariable logistic regression to adjust for confounders (Baseline NIHSS, Baseline mRS) with GraphPad Prism version 10.

Results: A total of 124 patients were included (45 rtPA, 79 non-rtPA). At 3 months, the proportion of patients achieving good outcomes (mRS 0–2) was significantly higher in the rtPA group (Odds ratio 4.39, 95% CI 1.56-12.40; p=0.003). At 6 months, the rtPA group still showed better outcomes (Odds ratio 2.51, 95% CI 0.67-9.41; p =0.16), though the difference was not statistically significant. Symptomatic ICH occurred in one patient (2.2%) in the rtPA group and none in the non-rtPA group

Conclusion: Intravenous rtPA in patients with minor stroke was associated with better short-term functional outcomes without increasing the risk of symptomatic intracranial hemorrhage. Long-term benefits were not statistically significant. Future prospective multicenter studies are warranted to validate these findings.

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