# A study of the safety and efficacy of multi-mode NMR-guided double-antiplatelet pretreatment combined with low-dose rtPA in the treatment of acute mild ischemic stroke

## TL;DR

This study found that combining dual antiplatelet therapy with low-dose rtPA, guided by MRI, improves outcomes in mild stroke patients without increasing bleeding risks.

## Contribution

The study introduces a novel treatment approach combining dual antiplatelet pretreatment and low-dose rtPA for acute mild ischemic stroke.

## Key findings

- The DAPT plus low-dose rtPA group showed significantly higher early neurological improvement and better 90-day functional outcomes.
- There was no significant increase in intracranial hemorrhage or mortality in the DAPT plus low-dose rtPA group.
- MRI guidance helped ensure safety without compromising efficacy in the treatment approach.

## Abstract

The objective of this study was to evaluate the safety and efficacy of dual antiplatelet pretreatment combined with low-dose rtPA therapy in patients with acute mild ischemic stroke, guided by multimodal MRI.

In this study, 383 patients with acute mild ischemic stroke (NIHSS ≤ 5) who had symptom onset within 4.5 hours of MRI screening were selected. Patients in the dual antiplatelet pretreatment plus low-dose rtPA group (164 cases) received dual antiplatelet therapy combined with low-dose (0.6 mg/kg) rtPA intravenous thrombolysis. Patients in the standard-dose group (112 cases) received conventional-dose (0.9 mg/kg) rtPA intravenous thrombolysis. Additionally, patients in the dual antiplatelet group who did not receive intravenous thrombolysis (107 cases) underwent 21 days of oral dual antiplatelet treatment.

There was no significant difference in the baseline NIHSS scores among the three groups before treatment (p > 0.05). The proportion of early neurological improvement within 24 hours and within 7 days was significantly higher in the DAPT plus low-dose group compared to both the standard-dose group and the DAPT group, with statistical significance (p < 0.05). After 90 days of follow-up, the proportion of good functional outcomes in the DAPT plus low-dose group was significantly higher than in both the standard-dose group and the DAPT group (p < 0.05), but there was no significant difference between the standard-dose group and the DAPT group. Safety studies indicated that, under MRI guidance, the DAPT plus low-dose group and the standard-dose group had lower incidences of intracranial hemorrhage transformation and symptomatic intracranial hemorrhage, with no statistical difference among the three groups (p > 0.05). Mortality rates were also similar across the three groups (p > 0.05), with only one patient passing away in the standard-dose group.

After dual antiplatelet pretreatment combined with low-dose rtPA intravenous thrombolysis for acute mild stroke under multimodal MRI guidance, the proportion of patients with good functional outcomes within 90 days was higher compared to the DAPT group and the standard-dose group, with statistical significance. There was no significant increase in the risk of cerebral hemorrhage compared to the standard-dose group and the DAPT group.