Antiplatelet Therapy vs Thrombolysis in Spinal Infarction

TOPLINEAmong patients with spontaneous spinal cord infarction (SCI), standard antiplatelet therapy was associated with significantly lower all-cause mortality compared with thrombolysis over a median follow-up of 180 days. No significant differences were observed in readmission rates or rehabilitation utilization between the two treatment approaches.METHODOLOGYA retrospective cohort study using the TriNetX Global Collaborative Network compared outcomes between standard antiplatelet therapy and thrombolytic therapy in patients with acute spontaneous SCI.A total of 192 patients were included after propensity score matching: 96 received standard antiplatelet therapy (aspirin, clopidogrel, or dipyridamole within 2 days of diagnosis) and 96 received thrombolytic therapy (alteplase or tenecteplase within 1 day of diagnosis); the mean age of the cohort was around 57 years, and 61.5%-63.5% were men.Propensity score matching balanced 68 covariates including demographics, stroke severity indicators (National Institutes of Health Stroke Scale categories), cardiovascular and metabolic comorbidities, lifestyle factors, infectious diseases, vascular anatomy, neurologic deficits, prior procedures, and baseline medications.The index date was defined as the point when a patient first had both an SCI diagnosis and the qualifying treatment.The primary outcome was all-cause mortality; readmission and rehabilitation utilization were secondary, exploratory outcomes — all assessed from 1 day after the index event to 180 days postindex.TAKEAWAYAll-cause mortality was significantly lower in the standard antiplatelet therapy cohort compared with the thrombolysis cohort (hazard ratio [HR], 0.42; P = .008).No significant difference was observed in all-cause readmission between standard antiplatelet therapy and thrombolysis cohorts.Rehabilitation utilization also showed no significant difference between the two groups.IN PRACTICE"The results support cautious individualized decision-making and argue against the routine extrapolation of cerebral thrombolysis protocols to spontaneous SCI," the authors wrote.SOURCEThe study was led by Majd A. AbuAlrob, MD, Department of Neurology, Hamad General Hospital, Hamad Medical Corporation in Doha, Qatar, and Ali Al-Salahat, MD, Department of Neurology, Creighton University School of Medicine, Omaha, Nebraska. It was published online on August 3 in Stroke.LIMITATIONSThe study relied on standard diagnostic codes without imaging confirmation of SCI. Because the exact time symptoms started wasn't recorded, the study couldn't tell whether treatment timing mattered. Rehabilitation use also isn't a real measure of recovery; it mostly reflects things like insurance coverage and local hospital practices.DISCLOSURESThe study received no funding. The authors reported no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.