When a spinal cord infarction strikes, the treatment playbook isn't as clear-cut as it is for brain strokes — and a new study suggests that borrowing cerebral stroke protocols may actually put patients at risk. Researchers compared outcomes in patients with spontaneous spinal cord infarction (SCI) who received either standard antiplatelet therapy (aspirin, clopidogrel, or dipyridamole) or thrombolytic therapy (alteplase or tenecteplase), and the results strongly favored the antiplatelet approach.

The retrospective cohort study, published in Stroke, used the TriNetX Global Collaborative Network and included 192 propensity-matched patients followed for up to 180 days. Those on antiplatelet therapy had significantly lower all-cause mortality, while readmission rates and rehabilitation utilization were similar between both groups.

By the Numbers:

• 192 total patients included (96 per group) after propensity score matching
• Hazard ratio for all-cause mortality: 0.42 favoring antiplatelet therapy (P = .008)
• Median follow-up: 180 days
• Mean patient age: ~57 years; ~61.5–63.5% male

Why it matters: These findings challenge the assumption that thrombolysis — a cornerstone of ischemic stroke care — translates safely to spinal cord infarction. The authors urge individualized clinical decision-making rather than a one-size-fits-all approach, a critical message given how rarely SCI is studied in large trials.