Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study

On behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and purpose: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. Methods: The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Results: Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Conclusions: Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.

Original languageEnglish
Pages (from-to)76-81
Number of pages6
JournalJournal of the Neurological Sciences
Volume399
DOIs
Publication statusPublished - 2019 Apr 15

Fingerprint

Tissue Plasminogen Activator
Cohort Studies
Stroke
Prospective Studies
Geriatrics
Intracranial Hemorrhages
Mortality
Safety

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

Cite this

On behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group. / Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients : A multicenter prospective cohort study. In: Journal of the Neurological Sciences. 2019 ; Vol. 399. pp. 76-81.
@article{dfc659a145a54255b073e1e7323ba158,
title = "Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study",
abstract = "Background and purpose: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. Methods: The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Results: Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2{\%} versus 34.8{\%}), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Conclusions: Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.",
author = "{On behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group} and Chao, {A. Ching} and Ke Han and Lin, {Sheng Feng} and Lin, {Ruey Tay} and Chih-Hung Chen and Lung Chan and Lin, {Huey Juan} and Yu Sun and Lin, {Yung Yang} and Chen, {Po Lin} and Lin, {Shinn Kuang} and Wei, {Cheng Yu} and Lin, {Yu Te} and Lee, {Jiunn Tay} and Hu, {Han Hwa} and Bai, {Chyi Huey}",
year = "2019",
month = "4",
day = "15",
doi = "10.1016/j.jns.2019.01.047",
language = "English",
volume = "399",
pages = "76--81",
journal = "Journal of the Neurological Sciences",
issn = "0022-510X",
publisher = "Elsevier",

}

Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients : A multicenter prospective cohort study. / On behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group.

In: Journal of the Neurological Sciences, Vol. 399, 15.04.2019, p. 76-81.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients

T2 - A multicenter prospective cohort study

AU - On behalf of the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group

AU - Chao, A. Ching

AU - Han, Ke

AU - Lin, Sheng Feng

AU - Lin, Ruey Tay

AU - Chen, Chih-Hung

AU - Chan, Lung

AU - Lin, Huey Juan

AU - Sun, Yu

AU - Lin, Yung Yang

AU - Chen, Po Lin

AU - Lin, Shinn Kuang

AU - Wei, Cheng Yu

AU - Lin, Yu Te

AU - Lee, Jiunn Tay

AU - Hu, Han Hwa

AU - Bai, Chyi Huey

PY - 2019/4/15

Y1 - 2019/4/15

N2 - Background and purpose: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. Methods: The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Results: Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Conclusions: Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.

AB - Background and purpose: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. Methods: The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Results: Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Conclusions: Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.

UR - http://www.scopus.com/inward/record.url?scp=85061561710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061561710&partnerID=8YFLogxK

U2 - 10.1016/j.jns.2019.01.047

DO - 10.1016/j.jns.2019.01.047

M3 - Article

C2 - 30780072

AN - SCOPUS:85061561710

VL - 399

SP - 76

EP - 81

JO - Journal of the Neurological Sciences

JF - Journal of the Neurological Sciences

SN - 0022-510X

ER -