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Antiplatelet therapy versus intravenous thrombolysis for mild acute ischaemic stroke: a living systematic review and meta-analysis

Mingzhen Qin, Tingting Liu, Xinyi Shi, Luda Feng, Tingting Li, Zixin Cheng, Sisong Cheng, Congren Zhou, Mingrun Zou, Qi Jia, Chi Zhang, Ying Gao
DOI: 10.1136/svn-2024-003097 Published 21 August 2024
Mingzhen Qin
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Tingting Liu
2Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
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Xinyi Shi
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Luda Feng
3Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Tingting Li
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Zixin Cheng
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Sisong Cheng
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Congren Zhou
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Mingrun Zou
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Qi Jia
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Chi Zhang
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Ying Gao
1Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
4Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
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    Figure 1

    Flow diagram.

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    Figure 2

    Forest plot of antiplatelet therapy versus IVT on excellent functional outcome at 90 days. IVT, intravenous thrombolysis; RCT, randomised clinical trial; M-H, Mantel-Haenszel.

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    Figure 3

    Forest plot of antiplatelet therapy versus IVT on death within 90 days. IVT, intravenous thrombolysis; RCT, randomised clinical trial; M-H, Mantel-Haenszel.

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    Figure 4

    Forest plot of antiplatelet therapy versus IVT on sICH within 90 days. IVT, intravenous thrombolysis; RCT, randomised clinical trial; sICH, symptomatic intracranial haemorrhage; M-H, Mantel-Haenszel.

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  • Table 1

    Characteristics of included studies

    StudyStudy designOriginDefinitionSymptom onset, hourSample sizeAntiplatelet therapyIVT therapyOutcome
    Chen 2023RCTChinaNIHSS≤5<4.5 hour719DAPTAlteplase①②③④
    Duan 2023Cohort studyChinaNIHSS≤5<4.5 hour1177DAPT/aspirin aloneIntravenous thrombolysis①②③
    Sykora 2023Cohort studyAustriaNIHSS≤3NA718DAPTIntravenous thrombolysis①④
    Wang 2021Cohort studyChinaNIHSS≤3<4.5 hour830DAPT/aspirin aloneIntravenous thrombolysis①②
    Lan 2020Cohort studyChinaNIHSS≤5NA218DAPTAlteplase①②③④
    Khatri 2018RCTUnited StatesNIHSS≤5<3 hour313Aspirin aloneAlteplase①②③④
    • ①Long-term functional outcomes; ②death; ③stroke or other vascular events; ④symptomatic intracranial haemorrhage.

    • DAPT, dual antiplatelet therapy; IVT, intravenous thrombolysis; NA, not applicable; NIHSS, National Institutes of Health Stroke Scale; RCT, randomised clinical trial.

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    [svn-2024-003097supp001.pdf]

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    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

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Antiplatelet therapy versus intravenous thrombolysis for mild acute ischaemic stroke: a living systematic review and meta-analysis
Mingzhen Qin, Tingting Liu, Xinyi Shi, Luda Feng, Tingting Li, Zixin Cheng, Sisong Cheng, Congren Zhou, Mingrun Zou, Qi Jia, Chi Zhang, Ying Gao
Stroke and Vascular Neurology Aug 2024, svn-2024-003097; DOI: 10.1136/svn-2024-003097

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Antiplatelet therapy versus intravenous thrombolysis for mild acute ischaemic stroke: a living systematic review and meta-analysis
Mingzhen Qin, Tingting Liu, Xinyi Shi, Luda Feng, Tingting Li, Zixin Cheng, Sisong Cheng, Congren Zhou, Mingrun Zou, Qi Jia, Chi Zhang, Ying Gao
Stroke and Vascular Neurology Aug 2024, svn-2024-003097; DOI: 10.1136/svn-2024-003097
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Antiplatelet therapy versus intravenous thrombolysis for mild acute ischaemic stroke: a living systematic review and meta-analysis
Mingzhen Qin, Tingting Liu, Xinyi Shi, Luda Feng, Tingting Li, Zixin Cheng, Sisong Cheng, Congren Zhou, Mingrun Zou, Qi Jia, Chi Zhang, Ying Gao
Stroke and Vascular Neurology Aug 2024, svn-2024-003097; DOI: 10.1136/svn-2024-003097
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