Abstract WP050: Intravenous Thrombolysis Vs Antithrombotic Therapy In Acute Ischemic Stroke With Low NIHSS And Vessel Occlusion: A Systematic Review And Meta-Analysis

Background: The optimal management of patients with acute ischemic stroke presenting with low National Institutes of Health Stroke Scale (NIHSS) scores and confirmed vessel occlusion remains uncertain. While intravenous thrombolysis (IVT) is standard in many cases, its benefit in this specific subgroup compared to antithrombotic therapy alone is debated. Objective: To evaluate the efficacy and safety of IV thrombolysis versus antithrombotic agents in patients with acute ischemic stroke, low NIHSS scores, and confirmed vessel occlusion. Methods: Literature search on PubMed, EMBASE, and Cochrane databases from inception up to 1 July 2025 was conducted. Five studies which reported clinical outcome, mortality, and symptomatic ICH were included in qualitative synthesis and meta-analysis. Results: Across the included studies, IV thrombolysis did not significantly improve the likelihood of achieving a good functional outcome compared to antithrombotics (OR 0.98; 95% CI 0.73–1.32; P = 0.89). Mortality rates were also similar between groups (OR 1.2; 95% CI 0.18–7.87; P = 0.85). There was a nonsignificant trend toward increased risk of SICH in the IVT group (OR 2.47; 95% CI 0.79–7.74; P = 0.12). Conclusion: In patients with acute ischemic stroke, low NIHSS, and confirmed vessel occlusion, treatment with IV thrombolysis was not associated with improved functional outcomes or reduced mortality compared to antithrombotic therapy, and carried a nonsignificant increase in the risk of SICH. These findings highlight the need for randomized controlled trials to guide optimal treatment strategies in this patient subgroup.