Cardiac Thrombus Does Not Increase Post-Alteplase Microbembolic Events: Machine Learning and Propensity Score Augmented Cohort Analysis of 434 Ischemic Stroke Patients with Bayesian Simulated Analysis of 100,000 Patients |Biomedgrid

Stroke kills more patients globally than any other disease outside of ischemic heart disease, with prompt systemic thrombolysis being the standard of care for the majority of strokes (acute ischemic stroke [AIS]) [1]. Its benefit over risk ratio is so notable that recent randomized trials were conducted to determine if the treatment window could be extended. Yet, there is a concern for embolic complications for patients who receive tissue plasminogen activator (tPA) in the setting of cardiac thrombi [2], with an estimated nearly 500,000 stroke patients annually with cardiac thrombus who may be at risk for such post-tPA complications [3,4]. But there are no adequately powered (let alone randomized) studies assessing post-thrombolysis embolization in patients with cardiac thrombus and AIS [5]. Our study is the first known to apply state-of-the-art machine learning augmentation of causal inference propensity score analysis (backed by Bayesian statistics to simulate a trial of 100,000 subjects) to evaluate if thrombolysis increases microembolic events (MEs) among cardiac thrombus patients with AIS.