Low Dose vs. Standard-Dose Alteplase for Patients With Acute Ischemic Stroke: Wang X, Robinson T, Lee T et al. JAMA Neurol 2017;74(11):1328-1335

Abstract

There is developing data for the use of low-dose intravenous alteplase (0.6mg/kg body weight; maximum 60 mg) compared to standard-dose alteplase (0.9mg/kg body weight; maximum 90 mg), however much of this data has been conflicting, especially across different patient populations. In the recently completed alteplase-dose evaluation arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (Enchanted), low-dose alteplase was not shown to meet the noninferiority margin defined by the modified Rankin score (mRS) compared to standard-dose alteplase. However, this initial arm did not evaluate the use of low-dose alteplase in specific populations which may benefit from the reduced risk of symptomatic intracerebral hemorrhage (sICH).