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The following is a summary of “Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review,” published in the November 2023 issue of Neurology by Wen et al.

Despite being an off-label treatment, repeated intravenous thrombolysis (RIVT) within 3 months may offer a safe and effective approach for managing early recurrent ischemic stroke.

Researchers performed a retrospective study to evaluate the factors influencing the efficacy and safety of RIVT in recurrent ischemic stroke within 3 months and to determine optimal treatment strategies.

They searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang Database for cases of RIVT in recurrent ischemic stroke within 3 months (February 1, 2023). Clinical characteristics were compared and evaluated between the good-outcome and poor-outcome groups and between those with symptomatic intracranial hemorrhage (sICH) and those without (non-sICH).

The results showed 16 studies comprising 24 cases of RIVT within 3 months. The patients’ ages ranged from 42 to 87 years (median 73.5 years), and the intervals between thrombolysis varied from 0.25 to 90 days (median 9.5 days). No significant differences were found between the good and poor outcome groups. (P>0.05). However, the disparities in the baseline National Institutes of Health Stroke Scale (NIHSS) score for the recurrent stroke (P=0.056) and good outcome after the previous Intravenous Thrombolysis (IVT) (P=0.054) almost reached statistical significance. Significant differences were observed between the non-sICH and sICH groups regarding the proportion of cardiogenic embolism (P=0.036), baseline NIHSS score in the recurrent stroke (P=0.007), and the interval between thrombolysis (P=0.041), with no significant difference in regression analysis.

They concluded that RIVT may be beneficial for certain patients with recurrent ischemic stroke within 3 months, but careful patient selection is crucial.

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03472-4