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
N1 - Funding Information:
Each author contributed to the conception and design of the study, acquisition, analysis, and interpretation of data. S.F.L wrote the first draft of the article. This study was supported by grants from Ministry of Science and Technology, taiwan (MOST) 104-2314-B-037-029 - and KMUH 104-4R53 .
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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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 -