Podcast 882: Thrombolytics for Minor Strokes

Contributor: Aaron Lessen MD

Educational Pearls:

How is the severity of a stroke assessed?

• Strokes are assessed by the NIH Stroke Scale (NIHSS), this scale has different tasks, such as asking the person to repeat words, move their arms, or follow simple instructions. The maximum score is 42 but any score over 21 is considered severe.

What would qualify as a minor storke?

• NIH<5

• This could be achieved with minor symptoms such as numbness

Should patients with minor strokes be given thrombolytics?

• A new study in JAMA published in June of 2023 sought to answer this question.

• This study compares the effectiveness of dual antiplatelet therapy (DAPT) with intravenous thrombolysis in patients with minor non-disabling acute ischemic stroke.

• The research involved 760 participants in China, and the primary measure was an excellent functional outcome at 90 days.

• The results showed that DAPT was non-inferior to intravenous alteplase, with 93.8% of patients in the DAPT group and 91.4% in the alteplase group achieving an excellent functional outcome.

• The study suggests that DAPT could be a viable alternative to intravenous thrombolysis for patients with minor non-disabling strokes within 4.5 hours of symptom onset.

• Additionally, the incidence of symptomatic intracerebral hemorrhage was low in both groups.

References

1. Chen HS, Cui Y, Zhou ZH, Zhang H, Wang LX, Wang WZ, Shen LY, Guo LY, Wang EQ, Wang RX, Han J, Dong YL, Li J, Lin YZ, Yang QC, Zhang L, Li JY, Wang J, Xia L, Ma GB, Lu J, Jiang CH, Huang SM, Wan LS, Piao XY, Li Z, Li YS, Yang KH, Wang DL, Nguyen TN; ARAMIS Investigators. Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke: The ARAMIS Randomized Clinical Trial. JAMA. 2023 Jun 27;329(24):2135-2144. doi: 10.1001/jama.2023.7827. PMID: 37367978; PMCID: PMC10300686.

Summarized by Jeffrey Olson, MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII