Approximately one-third of patients with AMIS experience long-term functional dependence. Although the effectiveness of intravenous alteplase in treating AMIS remains uncertain due to limited clinical data, dual antiplatelet therapy, using clopidogrel and aspirin, has been shown to reduce the risk of recurrent strokes without significantly increasing the risk of hemorrhage. However, the most effective overall treatment strategy for managing AMIS continues to be unclear, highlighting the need for further research in this area.

This meta-analysis of one randomized controlled trial and five observational cohort studies (n=7,366) compared dual antiplatelet therapy (DAPT; n=4,584) and intravenous thrombolysis (IVT; n=2,782). No significant differences were found between DAPT and IVT regarding excellent functional outcome (RR 0.97, 95% CI: 0.87-1.07, p=0.52, I²= 94%), sICH (RR 0.27, 95% CI: 0.05-1.38, p=0.12, I²= 72%), favorable functional outcome (RR 1.00, 95% CI: 0.97-1.03, p=0.97, I²= 49%), recurrent ischaemic stroke (RR 0.89, 95% CI: 0.59-1.34, p=0.59, I²= 0%), and all-cause mortality (RR 0.51, 95% CI: 0.21-1.23, p=0.13, I²=0%). However, early neurological deterioration was reduced in the DAPT group (RR 0.50, 95% CI: 0.28-0.89, p=0.02, I²= 77%).

In patients with AMIS, dual antiplatelet therapy and intravenous thrombolysis show comparable efficacy regarding functional outcomes, though DAPT is associated with a lower risk of early neurological deterioration.