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 language | English |
|---|---|
| Pages (from-to) | 76-81 |
| Number of pages | 6 |
| Journal | Journal of the Neurological Sciences |
| Volume | 399 |
| DOIs | |
| Publication status | Published - 2019 Apr 15 |
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All Science Journal Classification (ASJC) codes
- Neurology
- Clinical Neurology
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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 journal › Article
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.
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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
VL - 399
SP - 76
EP - 81
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
SN - 0022-510X
ER -