Efficacy and safety of low-dose alteplase in the treatment of acute ischemic stroke: comparison with standard dose of alteplase

Abstract

Objective To compare the efficacy and safety of low-dose and standard-dose alteplase intravenous thrombolytic therapy in patients with acute ischemic stroke and to investigate whether low-dose alteplase is more suitable for patients with acute ischemic stroke in China. Methods Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis from July 2016 to December 2018 in Anhui No. 2 Provincial People's Hospital were enrolled retrospectively. According to the dose of alteplase, they were divided into low-dose group (0.6 mg/kg, the total dose not exceeding 60 mg) and standard dose group (0.9 mg/kg, the total dose not exceeding 90 mg). The efficacy endpoint was the clinical outcome at 90 d after onset evaluated by the modified Rankin Scale (mRS). The mRS score 0-2 was defined as self-care in life, and 0-1 was defined as good outcome. The safety endpoints were the incidence of symptomatic intracerebral hemorrhage (sICH) within 24-48 h after thrombolytic therapy and the mortality at 3 months. Results A total of 103 patients were enrolled, including 45 in the low-dose group and 58 in the standard dose group. There were no significant differences in demography, baseline clinical data, as well as self-care and good outcome rates at 90 d between the 2 groups. The incidence of sICH in the low-dose group (National Institute of Neurological Disorders and Stroke criteria: 2.22% vs. 17.24%; χ2=4.521, P=0.033) and mortality at 90 d (6.67% vs. 24.14%; χ2=4.417, P=0.036) were significantly lower than those in the standard dose group. Conclusion The efficacy of low-dose alteplase in the treatment of acute ischemic stroke was comparable to that of standard dose, but the incidence of sICH and mortality at 90 d were significantly reduced, which might be more suitable for Chinese patients. Key words: Stroke; Brain ischemia; Thrombolytic therapy; Tissue plasminogen activator; Treatment outcome