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Abstract Details

Alteplase vs. Antiplatelets in Minor Ischemic Stroke (NIHSS = 5): A Network Meta-analysis
Cerebrovascular Disease and Interventional Neurology
P1 - Poster Session 1 (8:00 AM-9:00 AM)

Minor ischemic strokes with a National Institutes of Health Stroke Scale (NIHSS) score ≤ 5 present unique challenges in determining the optimal treatment strategy.

To compare the safety and efficacy of antiplatelet therapy and alteplase in the treatment of minor ischemic stroke.

We systematically searched the literature for related primary studies published up to September 2023. A network meta-analysis, comprising five studies involving 6466 participants, was conducted using the R language, comparing three treatment arms: intravenous alteplase (IV alteplase), Dual Antiplatelet Therapy (DAPT) with aspirin and clopidogrel, and aspirin alone.

Compared to IV alteplase, DAPT was significantly associated with a decreased risk of symptomatic intracranial hemorrhage (sICH) (RR, 0.11; 95% CI, 0.04-0.32, p< 0.01), while aspirin was associated with a non-significant difference (RR, 0.09; 95% CI, 0.01-1.62, p= 0.10).

 However, there were no significant differences observed for both DAPT and aspirin regarding modified Rankin Score (mRS) 0-1 [(RR, 1.08; 95% CI, 0.99-1.19, p= 0.08), (RR, 0.98; 95% CI, 0.87-1.12, p= 0.79), respectively], mRS 0-2 [(RR, 1.04; 95% CI, 0.98-1.10, p= 0.23), (RR, 1.00; 95% CI, 0.93-1.08, p= 0.97), respectively], recurrent stroke [(RR, 0.88; 95% CI, 0.55-1.40, p= 0.58), (RR, 0.89; 95% CI, 0.54-1.46, p= 0.64), respectively], any intracranial hemorrhage [(RR, 0.23; 95% CI, 0.05-1.09, p= 0.06), (RR, 0.45; 95% CI, 0.16-1.27, p= 0.13), respectively], and mortality [(RR, 0.65; 95% CI, 0.16-2.67, p= 0.55), (RR, 2.41; 95% CI, 0.53-11.004, p= 0.25), respectively].


On the Surface Under the Cumulative Ranking (SUCRA), DAPT was ranked highest for mRS 0-1 (93%), mRS 0-2 (86%), Any ICH (87%), mortality (84%), and recurrent stroke (62%). Notably, aspirin was ranked highest for sICH (74%).

In ischemic stroke with an NIHSS ≤5, DAPT (aspirin and clopidogrel)  and aspirin alone have comparable efficacy and safety to IV alteplase. Well-designed randomized clinical trials in this population are warranted.


No disclosure on file
Hesham Kelani, MD (One Brooklyn Health) Dr. Kelani has nothing to disclose.
No disclosure on file
No disclosure on file
David P. Lerner, MD (One Brooklyn Health) Dr. Lerner has received publishing royalties from a publication relating to health care.
Arthur D. Kay, MD (Brookdale Hospital) Dr. Kay has nothing to disclose.
Diana Greene-Chandos, MD (St. Louis University SOM/SSM Health, Dept of Neurology) Dr. Greene-Chandos has nothing to disclose.
Lisa R. Merlin, MD, FAAN (SUNY Downstate Medical Center) Dr. Merlin has nothing to disclose.