Abstract TP053: Efficacy and safety of urokinase intravenous thrombolysis in minor stroke with the large vessel occlusion: a subgroup analysis of the Thrombolysis of Urokinase for Minor Stroke trial

Introduction: Urokinase (UK) intravenous thrombolysis was not found to be superior to best medicine treatment in the TRUST trial (the ThRombolysis of Urokinase for minor Stroke Trial). Individuals with minor stroke and large vessel occlusion (LVO) increased risk of poor outcomes, the efficacy and safety of thrombolysis in those patients remains controversial. The post hoc analysis aimed to investigated the efficacy and safety of UK in LVO patients with minor stroke. Methods: Patients with responsible vessel examination data in the TRUST trial were included and divided into LVO group and non-LVO group in this post-hoc exploratory analysis. In each group, patients were further classified into UK intravenous thrombolysis and best medicine treatment. The primary efficacy outcome was the proportion of patients with a modified Rankin Score (mRS) of 0-1 at 90 days. The secondary efficacy outcomes consisted of the proportion of mRS 0-2 at 90-day, new vascular events within 90 days, early neurological deterioration and improvement within 36h, general health-related quality of life (EuroQoL group EQ-5D) score and Barthel Index≥ 95 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and mortality. Results: Of the 999 patients enrolled in the TRUST trial, 605 patients were included: 67 (11.1%) were classified into LVO group and 538 (88.9%) were non-LVO group. 45 (67.2%) and 464 (86.2%) cases achieved the excellent functional outcome in the LVO and non-LVO group, respectively. In the LVO group, UK intravenous thrombolysis improved early neurological function (Adjusted odd ratio [OR], 4.70, [95% CI, 1.08-20.54]), but did not improve the 90-day functional outcome (OR, 1.90, [95% CI, 0.55-6.53]) compared with best medicine treatment, and the similar results were observed in the non-LVO group. In the LVO group, 1patient in the Uk-treated (2.4%) group death compared to 4 patients in the best medicine treatment (14.8%) group (OR, 0.03, [95%CI, 0.01-1.82]). there was no patient experienced sICH in the sub-group analysis. Conclusions: In patients with minor stroke, intravenous thrombolysis with UK can improve early neurological function, but there is no difference in 90 days excellent functional outcome. Among minor stroke patients with LVO, intravenous thrombolysis with urokinase seems to reduce mortality, but there was no statistically significant difference.