Low-Versus Standard-Dose Alteplase for Ischemic Strokes Within 4.5 Hours A Comparative Effectiveness and Safety Study

被引：63

作者：

Kim, Beom Joon ^{[1
,2
]}

Han, Moon-Ku ^{[1
,2
]}

Park, Tai Hwan ^{[3
]}

Park, Sang-Soon ^{[3
]}

Lee, Kyung Bok ^{[4
]}

Lee, Byung-Chul ^{[5
]}

Yu, Kyung-Ho ^{[5
]}

Oh, Mi Sun ^{[5
]}

Cha, Jae Kwan ^{[6
]}

Kim, Dae-Hyun ^{[6
]}

Lee, Jun ^{[7
]}

Lee, Soo Joo ^{[8
]}

Ko, Youngchai ^{[8
]}

Park, Jong-Moo ^{[9
]}

Kang, Kyusik ^{[9
]}

Cho, Yong-Jin ^{[10
]}

Hong, Keun-Sik ^{[10
]}

Kim, Joon-Tae ^{[11
]}

Choi, Jay Chol ^{[12
]}

Kim, Dong-Eog ^{[13
]}

Shin, Dong-Ick ^{[14
]}

Kim, Wook-Joo ^{[15
]}

Lee, Juneyoung ^{[16
]}

Lee, Ji Sung ^{[17
]}

Yoon, Byung-Woo ^{[18
]}

Gorelick, Philip B. ^{[19
,20
]}

Bae, Hee-Joon ^{[1
,2
]}

机构：

[1] Seoul Natl Univ, Bundang Hosp, Dept Neurol, Songnam 463707, Gyeonggi Do, South Korea

[2] Seoul Natl Univ, Bundang Hosp, Cerebrovasc Ctr, Songnam 463707, Gyeonggi Do, South Korea

[3] Seoul Med Ctr, Dept Neurol, Seoul, South Korea

[4] Soonchunhyang Univ Hosp Seoul, Dept Neurol, Seoul, South Korea

[5] Hallym Univ, Sacred Heart Hosp, Dept Neurol, Anyang Si, South Korea

[6] Dong A Univ, Dept Neurol, Busan, South Korea

[7] Yeungnam Univ, Med Ctr, Dept Neurol, Daegu, South Korea

[8] Eulji Univ, Sch Med, Eulji Univ Hosp, Dept Neurol, Taejon, South Korea

[9] Eulji Gen Hosp, Dept Neurol, Seoul, South Korea

[10] Inje Univ, Ilsan Paik Hosp, Dept Neurol, Goyang Si, Gyeonggi Do, South Korea

[11] Chonnam Natl Univ Hosp, Dept Neurol, Gwangju, South Korea

[12] Jeju Natl Univ, Dept Neurol, Jeju, South Korea

[13] Dongguk Univ, Ilsan Hosp, Dept Neurol, Goyang Si, Gyeonggi Do, South Korea

[14] Chungbuk Natl Univ, Sch Med, Chungbuk Natl Univ Hosp, Dept Neurol, Cheongju, South Korea

[15] Ulsan Univ Hosp, Dept Neurol, Ulsan, South Korea

[16] Korea Univ, Coll Med, Dept Biostat, Seoul 136705, South Korea

[17] Asan Med Ctr, Clin Trial Ctr, Seoul, South Korea

[18] Seoul Natl Univ Hosp, Dept Neurol, Seoul 110744, South Korea

[19] Michigan State Univ, Coll Human Med, Dept Translat Sci & Mol Med, Grand Rapids, MI USA

[20] Mercy Hlth Hauenstein Neurosci, Grand Rapids, MI USA

来源：

STROKE | 2015年 / 46卷 / 09期

关键词：

acute ischemic stroke; hemorrhage; low-dose tPA; thrombolysis; tissue-type plasminogen activator; TISSUE-PLASMINOGEN ACTIVATOR; MG/KG INTRAVENOUS ALTEPLASE; MARGINAL STRUCTURAL MODELS; PROPENSITY SCORE; CHINESE PATIENTS; RT-PA; J-ACT; THROMBOLYSIS; TRIAL; REGISTRY;

D O I：

10.1161/STROKEAHA.115.010180

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-The low-dose (0.6 mg/kg) alteplase strategy to treat acute ischemic stroke patients became widespread in East Asian countries, without rigorous testing against standard-dose (0.9 mg/kg) alteplase treatment. Our aim was to investigate the comparative effectiveness and safety of the low-dose versus standard-dose intravenous alteplase strategy. Methods-A total of 1526 acute ischemic stroke patients who qualified for intravenous alteplase and treated within 4.5 hours were identified from a prospective, multicenter, and nationwide stroke registry database. Primary outcomes were a modified Rankin scale score of 0 to 1 at 3 months after stroke and occurrence of symptomatic hemorrhagic transformation. Inverse probability of low-dose alteplase weighting by propensity scores was used to remove baseline imbalances between the 2 groups, and variation among centers were also accounted using generalized linear mixed models with a random intercept. Results-Low-dose intravenous alteplase was given to 450 patients (29.5%) and standard-dose intravenous alteplase to 1076 patients (70.5%). Low-dose alteplase treatment was comparable to standard-dose therapy according to the following adjusted outcomes and odds ratios (95% confidence intervals): modified Rankin scale score 0 to 1 at 3 months and 0.95 (0.68-1.32); modified Rankin scale 0 to 2 at 3 months and 0.84 (0.62-1.15); symptomatic hemorrhagic transformation and 1.05 (0.65-1.70); and 3-month mortality and 0.54 (0.35-0.83). The associations were unchanged when the analysis was limited to those without endovascular recanalization. Conclusions-The low-dose alteplase strategy was comparable to the standard-dose treatment in terms of the effectiveness and safety.

引用

页码：2541 / 2548

页数：8

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