Body Weight, Not Thrombus-Burden Tissue Plasminogen Activator Dosing

Abstract

See related article, pages 2867–2871. After studies in cardiology that used body weight dosing, intravenous tissue plasminogen activator (tPA) dose for stroke (0.9 mg/kg alteplase, maximum 90 mg) emerged from small dose-escalation studies that started with doses far less than those for myocardial infarction.1 These studies were conducted before tests like CT angiography became readily available to determine thrombus location and extent in acute ischemic stroke. Current guidelines endorse this body weight-based dose as standard of care after pivotal randomized trials showed a significant benefit from systemic thrombolysis.2,3 During clinical trials and in daily practice, clinicians have to obtain body weight (actual or estimate) urgently when special beds equipped with calibrated scales are generally not available in emergency departments. Weighing the patient without a stretcher with built-in bed scales would require a Hoyer lift scale, and because tPA should be given as soon as possible, this could delay care. As a result, dosing errors could be frequent. These errors were documented by many across different patient populations.4,5 Bruer et al provide a useful account that details body weight estimation …