Association of Butylphthalide Combined with Antiplatelet Therapy with Functional Recovery After Intravenous Thrombolysis in Acute Ischemic Stroke

Intravenous thrombolysis (IVT) is an established treatment for acute ischemic stroke, but functional outcomes remain suboptimal, and real-world evidence regarding adjunctive butylphthalide therapy is limited. This single-center retrospective observational study evaluated the association between adjunctive butylphthalide plus antiplatelet therapy and functional recovery after IVT in 118 patients with acute ischemic stroke treated between January 2024 and December 2025. Patients were classified by post-thrombolysis treatment: 62 received butylphthalide plus standard antiplatelet therapy, and 56 received standard antiplatelet therapy alone. After propensity score matching, 52 patients were retained in each group. The primary outcome was 90-day functional prognosis, with a modified Rankin Scale score of 0-2 defined as a favorable outcome. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) score, infarct volume, cerebral blood flow (CBF) perfusion recovery, serum high-sensitivity C-reactive protein (hs-CRP), plasma D-dimer (D-D), Barthel Index (BI) score, and adverse events. Multivariable logistic regression was used to identify factors associated with poor 90-day functional prognosis. Baseline characteristics were balanced between the matched groups (all P > 0.05). At 90 days, the butylphthalide combination group had a higher rate of favorable functional prognosis than the antiplatelet-only group (73.1% vs. 48.1%, P = 0.009). The combination group also had lower NIHSS scores, smaller infarct volumes, lower hs-CRP and D-D levels, better CBF perfusion recovery, and higher BI scores (all P < 0.05). Adverse event rates did not differ significantly between groups (P = 0.631). Multivariable analysis identified the treatment regimen as independently associated with 90-day functional prognosis (P = 0.009). Adjunctive butylphthalide plus antiplatelet therapy after IVT was associated with better 90-day functional recovery in this retrospective cohort; however, the observational design does not permit causal inference, and the safety findings are limited to the prespecified events reported here.