Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours: A Comparative Effectiveness and Safety Study

Beom Joon Kim, Moon Ku Han, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Jun Lee, Soo Joo Lee, Youngchai Ko, Jong Moo Park, Kyusik Kang, Yong Jin Cho, Keun Sik Hong, Joon Tae Kim, Jay Chol Choi, Dong Eog KimDong Ick Shin, Wook Joo Kim, Juneyoung Lee, Ji Sung Lee, Byung Woo Yoon, Philip B. Gorelick, Hee Joon Bae

Research output: Contribution to journalArticle

33 Citations (Scopus)

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 languageEnglish
Pages (from-to)2541-2548
Number of pages8
JournalStroke
Volume46
Issue number9
DOIs
Publication statusPublished - 2015 Sep 28

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Tissue Plasminogen Activator
Stroke
Safety
Propensity Score
Therapeutics
Registries
Linear Models
Odds Ratio
Databases
Confidence Intervals
Mortality

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

Kim, B. J., Han, M. K., Park, T. H., Park, S. S., Lee, K. B., Lee, B. C., ... Bae, H. J. (2015). Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours: A Comparative Effectiveness and Safety Study. Stroke, 46(9), 2541-2548. https://doi.org/10.1161/STROKEAHA.115.010180

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 journalArticle

Kim, BJ, Han, MK, Park, TH, Park, SS, Lee, KB, Lee, BC, Yu, KH, Oh, MS, Cha, JK, Kim, DH, Lee, J, Lee, SJ, Ko, Y, Park, JM, Kang, K, Cho, YJ, Hong, KS, Kim, JT, Choi, JC, Kim, DE, Shin, DI, Kim, WJ, Lee, J, Lee, JS, Yoon, BW, Gorelick, PB & Bae, HJ 2015, 'Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours: A Comparative Effectiveness and Safety Study', Stroke, vol. 46, no. 9, pp. 2541-2548. https://doi.org/10.1161/STROKEAHA.115.010180
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. / Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours : A Comparative Effectiveness and Safety Study. In: Stroke. 2015 ; Vol. 46, No. 9. pp. 2541-2548.
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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

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KW - thrombolysis

KW - tissue-type plasminogen activator

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