UK Stroke Forum 2025 | Evolving evidence on the use of thrombolysis in patients with minor stroke

I think the evidence has become more complex over time. I think we previously accepted that even if you had a low NIH score, this was still consistent with benefit from thrombolysis, but there are significant problems with those trials from which the evidence was derived. Most of them were undertaken prior to there being good evidence for acute use of antiplatelet therapy and indeed excluded antiplatelet therapy for 24 hours after participation in the trials. They also excluded the majority of patients with what was defined quite loosely as non-disabling minor stroke or quickly improving symptoms. And they also mostly lacked what we’d regard as modern imaging to define who had or had not had a stroke. So the data are quite compromised. The more recent trials where they’ve included either non-disabling or both non-disabling and disabling minor stroke have all rather consistently shown that thrombolytics are no more effective than antiplatelet therapy and have associated higher risks of intracerebral hemorrhage. The risks are not very high in absolute terms, but they are certainly in relative terms significantly increased.

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