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SINGLE-CENTRE, RETROSPECTIVE, CASE-CONTROL STUDY OF LOW-DOSE VS. STANDARD-DOSE THROMBOLYSIS IN ACUTE ISCHEMIC STROKE

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ESOC-2019

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Abstract

Background and Aims. Low-dose intravenous thrombolysis is a possible option in older patients with borderline criteria fulfilment (Chao AC, 2019). Low dose rtPA is currently used in Japanese subjects (Yamaguchi, 2006), however, limited data and no clear evidence of benefit is available for Caucasian-descent patients (Cheng JW, 2018). Our aim was to evaluate safety and efficacy of low- dose thrombolysis in Italian tertiary care stroke patients’ cohort. Methods. Retrospective study of 40 consecutive acute ischemic stroke patients treated in a tertiary care centre between 2013 and 2018 with low-dose (0.60±0.15 mg/kg) alteplase, propensity score-matched with 80 stroke patients treated with standard-dose (0.9 mg/kg) alteplase. Three-months modified Rankin scale (mRS) score was primary outcome; haemorrhagic transformation rate was safety outcome. Results. We assessed 120 patients with median age 76, baseline NIHSS score 12; 24/120 (20.0%) subjects received additional endovascular treatment. Clinical-demographic variables were comparable between case and control group; trend for significance was observed only for median premorbid mRS score, namely 0 (IQR 2) in low-dose vs. 0 (IQR 0) in control group (p=0.11), and prior dual antiplatelet therapy 3/40 (7.5%) in low-dose vs. 1/80 (1.3%) in control group (p=0.16). Low-dose group received median 0.66 (IQR 0.14) mg/kg alteplase, while standard-dose group 0.90 (0.01) mg/kg, at a median of 170 (53) minutes from symptom onset. Good outcome (3-month mRS≤2) was observed in 21/40 (52.5%) low-dose patients and 42/80 (52.5%) standard-dose patients (p=1.00); median 3-month mRS was 2 (IQR 3) for both groups, with mean utility-weighted mRS of 0.62 (SD 0.34) in low- dose vs. 0.66 (SD 0.30) in standard-dose group (p=0.35). No difference in haemorrhagic transformation rate was observed (p=1.00): 15% for both groups; of which 2.5% symptomatic (NIHSS change ≥4 points). Conclusions. Efficacy and safety of low-dose rtPA were comparable to standard-dose rtPA. Due to the small number of patients, the results of this exploratory study cannot be generalized and need to be confirmed in a larger stroke population. However, it appears feasible to consider using low- dose rtPA in frail stroke subjects population with higher risk of haemorragic transofrmation. References 1 Chao AC et al. Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study. J Neurol Sci. 2019 Apr 15;399:76-81
2. Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke 2006;37:1810-5 
3. Cheng JW et al. Low-dose tissue plasminogen activator in acute ischemic stroke: a systematic review and meta-analysis. J Stroke Cerebrovasc.Dis 2018 Feb;27(2):381-390

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© Copyright 2019 Morressier GmbH.
All rights reserved.