Highlight
• Standard antiplatelet therapy demonstrated a significantly lower all-cause mortality compared to thrombolytic treatment in spontaneous SCI.
• No significant difference was found between the two approaches in hospital readmission or rehabilitation utilization at 180 days.
• Findings suggest potential risks from off-label thrombolytic use in SCI and underscore the need for high-quality, prospective studies.
• Propensity score matching adjusted for 68 clinical covariates, enhancing the validity of comparative outcome assessment.
