Abstract
BackgroundThe efficacy and safety of intravenous alteplase administered 3–4.5 h after acute ischemic stroke have been demonstrated. However, whether responses differ between low-dose and standard-dose alteplase during this time window and whether certain subgroups benefit more remain unknown.Patients and MethodsThe current analysis was based on a multicenter matched-cohort study conducted in Taiwan. The treatment group comprised 378 patients receiving intravenous alteplase 3–4.5 h after stroke onset, and the control group comprised 378 age- and sex-matched patients who did not receive alteplase treatment during the same period. Standard- and low-dose alteplase was administered to patients at the physician's discretion.ResultsOverall, patients receiving alteplase exhibited more favorable outcomes than did controls [34.0 vs. 22.7%; odds ratio (OR): 1.75, 95% confidence interval (CI): 1.27–1.42], and the effectiveness was consistent in all subgroups. Although patients in the standard-dose group (n = 182) were younger than those in the low-dose (n = 192) group, the proportions of patients with favorable outcomes (36.3 vs. 31.8%; OR: 1.22, 95% CI: 0.80–1.88) and symptomatic hemorrhage (2.8 vs 4.2%; OR: 0.65, 95% CI: 0.21–2.02) were consistently comparable in a covariate-adjusted model and an age-matched cohort. In the subgroup analysis, patients with cardioembolism, atrial fibrillation, and hypercholesterolemia were more likely to achieve favorable outcomes after receiving standard-dose than low-dose alteplase.ConclusionIn the 3–4.5 h time window, the effectiveness and safety of standard-dose and low-dose alteplase may be comparable. A standard dose may be selected for patients with cardioembolism, atrial fibrillation, or hypercholesterolemia.
Highlights
The efficacy and safety of intravenous thrombolysis with 0.9 mg/kg alteplase at 3–4.5 h after acute ischemic stroke (AIS) were first demonstrated in the European Cooperative Acute Stroke Study III [ECASS III; [1]] and have been subsequently verified by a meta-analysis [2] and several realworld studies [3,4,5]
The ENhanced Control of Hypertension And Thrombolysis strokE stuDy (ENCHANTED) demonstrated that low-dose alteplase was not non-inferior to standard-dose alteplase in reducing death and disability when used within 4.5 h of stroke onset, significantly fewer symptomatic intracerebral hemorrhage (ICH) events were reported in the lowdose group than in the standard-dose group [10]
This study involved the analysis of data from a multicenter, retrospective, matched-cohort study initiated by the Taiwan Stroke Society to evaluate the effectiveness and safety of intravenous alteplase at 3–4.5 h after symptom onset in patients with AIS
Summary
The efficacy and safety of intravenous thrombolysis with 0.9 mg/kg alteplase at 3–4.5 h after acute ischemic stroke (AIS) were first demonstrated in the European Cooperative Acute Stroke Study III [ECASS III; [1]] and have been subsequently verified by a meta-analysis [2] and several realworld studies [3,4,5]. The ENhanced Control of Hypertension And Thrombolysis strokE stuDy (ENCHANTED) demonstrated that low-dose alteplase was not non-inferior to standard-dose alteplase in reducing death and disability when used within 4.5 h of stroke onset, significantly fewer symptomatic ICH (sICH) events were reported in the lowdose group than in the standard-dose group [10]. Whether responses differ between low-dose and standard-dose alteplase during this time window and whether certain subgroups benefit more remain unknown
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