Abstract
Background and Purpose - The low-dose (0.6 mg/kg) alteplase strategy to treat acute ischemic stroke patients became widespread in East Asian countries, without rigorous testing against standard-dose (0.9 mg/kg) alteplase treatment. Our aim was to investigate the comparative effectiveness and safety of the low-dose versus standard-dose intravenous alteplase strategy. Methods - A total of 1526 acute ischemic stroke patients who qualified for intravenous alteplase and treated within 4.5 hours were identified from a prospective, multicenter, and nationwide stroke registry database. Primary outcomes were a modified Rankin scale score of 0 to 1 at 3 months after stroke and occurrence of symptomatic hemorrhagic transformation. Inverse probability of low-dose alteplase weighting by propensity scores was used to remove baseline imbalances between the 2 groups, and variation among centers were also accounted using generalized linear mixed models with a random intercept. Results - Low-dose intravenous alteplase was given to 450 patients (29.5%) and standard-dose intravenous alteplase to 1076 patients (70.5%). Low-dose alteplase treatment was comparable to standard-dose therapy according to the following adjusted outcomes and odds ratios (95% confidence intervals): modified Rankin scale score 0 to 1 at 3 months and 0.95 (0.68-1.32); modified Rankin scale 0 to 2 at 3 months and 0.84 (0.62-1.15); symptomatic hemorrhagic transformation and 1.05 (0.65-1.70); and 3-month mortality and 0.54 (0.35-0.83). The associations were unchanged when the analysis was limited to those without endovascular recanalization. Conclusions - The low-dose alteplase strategy was comparable to the standard-dose treatment in terms of the effectiveness and safety.
| Original language | English |
|---|---|
| Pages (from-to) | 2541-2548 |
| Number of pages | 8 |
| Journal | Stroke |
| Volume | 46 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 2015 Sep 28 |
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Keywords
- acute ischemic stroke
- hemorrhage
- low-dose tPA
- thrombolysis
- tissue-type plasminogen activator
ASJC Scopus subject areas
- Clinical Neurology
- Cardiology and Cardiovascular Medicine
- Advanced and Specialised Nursing
Cite this
Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours : A Comparative Effectiveness and Safety Study. / Kim, Beom Joon; Han, Moon Ku; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Cha, Jae Kwan; Kim, Dae Hyun; Lee, Jun; Lee, Soo Joo; Ko, Youngchai; Park, Jong Moo; Kang, Kyusik; Cho, Yong Jin; Hong, Keun Sik; Kim, Joon Tae; Choi, Jay Chol; Kim, Dong Eog; Shin, Dong Ick; Kim, Wook Joo; Lee, Juneyoung; Lee, Ji Sung; Yoon, Byung Woo; Gorelick, Philip B.; Bae, Hee Joon.
In: Stroke, Vol. 46, No. 9, 28.09.2015, p. 2541-2548.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours
T2 - A Comparative Effectiveness and Safety Study
AU - Kim, Beom Joon
AU - Han, Moon Ku
AU - Park, Tai Hwan
AU - Park, Sang Soon
AU - Lee, Kyung Bok
AU - Lee, Byung Chul
AU - Yu, Kyung Ho
AU - Oh, Mi Sun
AU - Cha, Jae Kwan
AU - Kim, Dae Hyun
AU - Lee, Jun
AU - Lee, Soo Joo
AU - Ko, Youngchai
AU - Park, Jong Moo
AU - Kang, Kyusik
AU - Cho, Yong Jin
AU - Hong, Keun Sik
AU - Kim, Joon Tae
AU - Choi, Jay Chol
AU - Kim, Dong Eog
AU - Shin, Dong Ick
AU - Kim, Wook Joo
AU - Lee, Juneyoung
AU - Lee, Ji Sung
AU - Yoon, Byung Woo
AU - Gorelick, Philip B.
AU - Bae, Hee Joon
PY - 2015/9/28
Y1 - 2015/9/28
N2 - Background and Purpose - The low-dose (0.6 mg/kg) alteplase strategy to treat acute ischemic stroke patients became widespread in East Asian countries, without rigorous testing against standard-dose (0.9 mg/kg) alteplase treatment. Our aim was to investigate the comparative effectiveness and safety of the low-dose versus standard-dose intravenous alteplase strategy. Methods - A total of 1526 acute ischemic stroke patients who qualified for intravenous alteplase and treated within 4.5 hours were identified from a prospective, multicenter, and nationwide stroke registry database. Primary outcomes were a modified Rankin scale score of 0 to 1 at 3 months after stroke and occurrence of symptomatic hemorrhagic transformation. Inverse probability of low-dose alteplase weighting by propensity scores was used to remove baseline imbalances between the 2 groups, and variation among centers were also accounted using generalized linear mixed models with a random intercept. Results - Low-dose intravenous alteplase was given to 450 patients (29.5%) and standard-dose intravenous alteplase to 1076 patients (70.5%). Low-dose alteplase treatment was comparable to standard-dose therapy according to the following adjusted outcomes and odds ratios (95% confidence intervals): modified Rankin scale score 0 to 1 at 3 months and 0.95 (0.68-1.32); modified Rankin scale 0 to 2 at 3 months and 0.84 (0.62-1.15); symptomatic hemorrhagic transformation and 1.05 (0.65-1.70); and 3-month mortality and 0.54 (0.35-0.83). The associations were unchanged when the analysis was limited to those without endovascular recanalization. Conclusions - The low-dose alteplase strategy was comparable to the standard-dose treatment in terms of the effectiveness and safety.
AB - Background and Purpose - The low-dose (0.6 mg/kg) alteplase strategy to treat acute ischemic stroke patients became widespread in East Asian countries, without rigorous testing against standard-dose (0.9 mg/kg) alteplase treatment. Our aim was to investigate the comparative effectiveness and safety of the low-dose versus standard-dose intravenous alteplase strategy. Methods - A total of 1526 acute ischemic stroke patients who qualified for intravenous alteplase and treated within 4.5 hours were identified from a prospective, multicenter, and nationwide stroke registry database. Primary outcomes were a modified Rankin scale score of 0 to 1 at 3 months after stroke and occurrence of symptomatic hemorrhagic transformation. Inverse probability of low-dose alteplase weighting by propensity scores was used to remove baseline imbalances between the 2 groups, and variation among centers were also accounted using generalized linear mixed models with a random intercept. Results - Low-dose intravenous alteplase was given to 450 patients (29.5%) and standard-dose intravenous alteplase to 1076 patients (70.5%). Low-dose alteplase treatment was comparable to standard-dose therapy according to the following adjusted outcomes and odds ratios (95% confidence intervals): modified Rankin scale score 0 to 1 at 3 months and 0.95 (0.68-1.32); modified Rankin scale 0 to 2 at 3 months and 0.84 (0.62-1.15); symptomatic hemorrhagic transformation and 1.05 (0.65-1.70); and 3-month mortality and 0.54 (0.35-0.83). The associations were unchanged when the analysis was limited to those without endovascular recanalization. Conclusions - The low-dose alteplase strategy was comparable to the standard-dose treatment in terms of the effectiveness and safety.
KW - acute ischemic stroke
KW - hemorrhage
KW - low-dose tPA
KW - thrombolysis
KW - tissue-type plasminogen activator
UR - http://www.scopus.com/inward/record.url?scp=84940398535&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84940398535&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.115.010180
DO - 10.1161/STROKEAHA.115.010180
M3 - Article
C2 - 26243232
AN - SCOPUS:84940398535
VL - 46
SP - 2541
EP - 2548
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 9
ER -