Objective: To compare the effects of intravenous alteplase thrombolysis on clinical outcomes and safety between patients with anterior and posterior circulation cerebral infarction. Methods: Between April 2019 and December 2024, 319 patients with acute cerebral infarction underwent intravenous alteplase thrombolysis within 4.5 hours at Zhuhai People’s Hospital. They were divided by infarction site into anterior (n = 219) and posterior (n = 100) circulation groups. Comparisons were made for baseline risk factors, serial National Institute of Health stroke scale (NIHSS) scores, clinical efficacy, discharge mRS scores, and rates of bleeding complications (symptomatic or asymptomatic intracranial hemorrhages, oral/gingival, cutaneous, and gastrointestinal). Results: Baseline Characteristics: The ACS group had a higher proportion of atrial fibrillation, while hypertension and diabetes were more prevalent in the PCS group (both P < 0.05). Efficacy Outcomes: No significant differences were observed between the two groups in NIHSS scores at any time point (pre-thrombolysis, 24 h, and 7 d) or in the overall clinical improvement rate. Safety Outcomes: The rate of intracranial hemorrhage was significantly higher in the ACS group (P < 0.05). Rates of other bleeding events (oral/gingival, cutaneous, gastrointestinal) and total bleeding, as well as mortality, did not differ significantly between groups (P > 0.05). Conclusion: While atrial fibrillation is more common in anterior circulation infarction, hypertension and diabetes are more frequent in posterior circulation infarction. Early alteplase thrombolysis significantly and similarly improves prognosis in both types. For safety, posterior circulation infarction carries a lower risk of intracranial hemorrhage but comparable risks of extracranial bleeding.
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