Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients

A. Ching Chao, Ching Kuan Liu, Chih Hung Chen, Huey Juan Lin, Chung Hsiang Liu, Jiann Shing Jeng, Chaur Jong Hu, Chih Ping Chung, Hung Yi Hsu, Wen Yung Sheng, Han Hwa Hu

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Abstract

BACKGROUND AND PURPOSE - : The relationship between the dose of recombinant tissue-type plasminogen activator (r-tPA) and its safety/efficacy for ischemic stroke has not been well evaluated in the East Asian population. We assessed the safety/efficacy of different doses of r-tPA for acute ischemic stroke in Chinese patients. METHODS - : A total of 1004 eligible patients were classified according to the dose of r-tPA received for managing acute ischemic stroke: 0.9 mg/kg (n=422), 0.8 mg/kg (n=202), 0.7 mg/kg (n=199), and 0.6 mg/kg (n=181). The safety outcome was symptomatic intracerebral hemorrhage and death within 3 months. The efficacy outcome was good functional outcome (modified Rankin Scale ≤1) at 3 months. RESULTS - : There was a significant trend for symptomatic intracerebral hemorrhage with age (P=0.002). With multivariate logistic regression analysis, a dose of 0.9 mg/kg was a predictor of symptomatic intracerebral hemorrhage (P=0.0109), and a dose ≤0.65 mg/kg was a predictor of good functional outcome (P=0.0369). In patients aged 71 to 80 years, there was a significant trend of increasing symptomatic intracerebral hemorrhage (P=0.0130) and less good functional outcome (P=0.0179) with increasing doses of r-tPA. There was also a trend of increasing mortality (P=0.0971) at 3 months in these patients. CONCLUSIONS - : These results did not support the dose of 0.9 mg/kg of r-tPA being optimal for all patients in the East Asian population. In elderly patients (71-80 years), a lower dose of 0.6 mg/kg is associated with a better outcome. Confirmation of the results through randomized trial is required.

Original languageEnglish
Pages (from-to)2359-2365
Number of pages7
JournalStroke
Volume45
Issue number8
DOIs
Publication statusPublished - 2014 Aug

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Tissue Plasminogen Activator
Stroke
Cerebral Hemorrhage
Safety
Population
Logistic Models
Regression Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Chao, A. Ching ; Liu, Ching Kuan ; Chen, Chih Hung ; Lin, Huey Juan ; Liu, Chung Hsiang ; Jeng, Jiann Shing ; Hu, Chaur Jong ; Chung, Chih Ping ; Hsu, Hung Yi ; Sheng, Wen Yung ; Hu, Han Hwa. / Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients. In: Stroke. 2014 ; Vol. 45, No. 8. pp. 2359-2365.
@article{a66ca5459d5d434fb100b086da1cf28a,
title = "Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients",
abstract = "BACKGROUND AND PURPOSE - : The relationship between the dose of recombinant tissue-type plasminogen activator (r-tPA) and its safety/efficacy for ischemic stroke has not been well evaluated in the East Asian population. We assessed the safety/efficacy of different doses of r-tPA for acute ischemic stroke in Chinese patients. METHODS - : A total of 1004 eligible patients were classified according to the dose of r-tPA received for managing acute ischemic stroke: 0.9 mg/kg (n=422), 0.8 mg/kg (n=202), 0.7 mg/kg (n=199), and 0.6 mg/kg (n=181). The safety outcome was symptomatic intracerebral hemorrhage and death within 3 months. The efficacy outcome was good functional outcome (modified Rankin Scale ≤1) at 3 months. RESULTS - : There was a significant trend for symptomatic intracerebral hemorrhage with age (P=0.002). With multivariate logistic regression analysis, a dose of 0.9 mg/kg was a predictor of symptomatic intracerebral hemorrhage (P=0.0109), and a dose ≤0.65 mg/kg was a predictor of good functional outcome (P=0.0369). In patients aged 71 to 80 years, there was a significant trend of increasing symptomatic intracerebral hemorrhage (P=0.0130) and less good functional outcome (P=0.0179) with increasing doses of r-tPA. There was also a trend of increasing mortality (P=0.0971) at 3 months in these patients. CONCLUSIONS - : These results did not support the dose of 0.9 mg/kg of r-tPA being optimal for all patients in the East Asian population. In elderly patients (71-80 years), a lower dose of 0.6 mg/kg is associated with a better outcome. Confirmation of the results through randomized trial is required.",
author = "Chao, {A. Ching} and Liu, {Ching Kuan} and Chen, {Chih Hung} and Lin, {Huey Juan} and Liu, {Chung Hsiang} and Jeng, {Jiann Shing} and Hu, {Chaur Jong} and Chung, {Chih Ping} and Hsu, {Hung Yi} and Sheng, {Wen Yung} and Hu, {Han Hwa}",
year = "2014",
month = "8",
doi = "10.1161/STROKEAHA.114.005245",
language = "English",
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Chao, AC, Liu, CK, Chen, CH, Lin, HJ, Liu, CH, Jeng, JS, Hu, CJ, Chung, CP, Hsu, HY, Sheng, WY & Hu, HH 2014, 'Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients', Stroke, vol. 45, no. 8, pp. 2359-2365. https://doi.org/10.1161/STROKEAHA.114.005245

Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients. / Chao, A. Ching; Liu, Ching Kuan; Chen, Chih Hung; Lin, Huey Juan; Liu, Chung Hsiang; Jeng, Jiann Shing; Hu, Chaur Jong; Chung, Chih Ping; Hsu, Hung Yi; Sheng, Wen Yung; Hu, Han Hwa.

In: Stroke, Vol. 45, No. 8, 08.2014, p. 2359-2365.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Different doses of recombinant tissue-type plasminogen activator for acute stroke in Chinese patients

AU - Chao, A. Ching

AU - Liu, Ching Kuan

AU - Chen, Chih Hung

AU - Lin, Huey Juan

AU - Liu, Chung Hsiang

AU - Jeng, Jiann Shing

AU - Hu, Chaur Jong

AU - Chung, Chih Ping

AU - Hsu, Hung Yi

AU - Sheng, Wen Yung

AU - Hu, Han Hwa

PY - 2014/8

Y1 - 2014/8

N2 - BACKGROUND AND PURPOSE - : The relationship between the dose of recombinant tissue-type plasminogen activator (r-tPA) and its safety/efficacy for ischemic stroke has not been well evaluated in the East Asian population. We assessed the safety/efficacy of different doses of r-tPA for acute ischemic stroke in Chinese patients. METHODS - : A total of 1004 eligible patients were classified according to the dose of r-tPA received for managing acute ischemic stroke: 0.9 mg/kg (n=422), 0.8 mg/kg (n=202), 0.7 mg/kg (n=199), and 0.6 mg/kg (n=181). The safety outcome was symptomatic intracerebral hemorrhage and death within 3 months. The efficacy outcome was good functional outcome (modified Rankin Scale ≤1) at 3 months. RESULTS - : There was a significant trend for symptomatic intracerebral hemorrhage with age (P=0.002). With multivariate logistic regression analysis, a dose of 0.9 mg/kg was a predictor of symptomatic intracerebral hemorrhage (P=0.0109), and a dose ≤0.65 mg/kg was a predictor of good functional outcome (P=0.0369). In patients aged 71 to 80 years, there was a significant trend of increasing symptomatic intracerebral hemorrhage (P=0.0130) and less good functional outcome (P=0.0179) with increasing doses of r-tPA. There was also a trend of increasing mortality (P=0.0971) at 3 months in these patients. CONCLUSIONS - : These results did not support the dose of 0.9 mg/kg of r-tPA being optimal for all patients in the East Asian population. In elderly patients (71-80 years), a lower dose of 0.6 mg/kg is associated with a better outcome. Confirmation of the results through randomized trial is required.

AB - BACKGROUND AND PURPOSE - : The relationship between the dose of recombinant tissue-type plasminogen activator (r-tPA) and its safety/efficacy for ischemic stroke has not been well evaluated in the East Asian population. We assessed the safety/efficacy of different doses of r-tPA for acute ischemic stroke in Chinese patients. METHODS - : A total of 1004 eligible patients were classified according to the dose of r-tPA received for managing acute ischemic stroke: 0.9 mg/kg (n=422), 0.8 mg/kg (n=202), 0.7 mg/kg (n=199), and 0.6 mg/kg (n=181). The safety outcome was symptomatic intracerebral hemorrhage and death within 3 months. The efficacy outcome was good functional outcome (modified Rankin Scale ≤1) at 3 months. RESULTS - : There was a significant trend for symptomatic intracerebral hemorrhage with age (P=0.002). With multivariate logistic regression analysis, a dose of 0.9 mg/kg was a predictor of symptomatic intracerebral hemorrhage (P=0.0109), and a dose ≤0.65 mg/kg was a predictor of good functional outcome (P=0.0369). In patients aged 71 to 80 years, there was a significant trend of increasing symptomatic intracerebral hemorrhage (P=0.0130) and less good functional outcome (P=0.0179) with increasing doses of r-tPA. There was also a trend of increasing mortality (P=0.0971) at 3 months in these patients. CONCLUSIONS - : These results did not support the dose of 0.9 mg/kg of r-tPA being optimal for all patients in the East Asian population. In elderly patients (71-80 years), a lower dose of 0.6 mg/kg is associated with a better outcome. Confirmation of the results through randomized trial is required.

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U2 - 10.1161/STROKEAHA.114.005245

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