Response to Letter by Chan
We appreciate the comments by Chan concerning our article entitled “Outcomes of Thrombolytic Therapy for Acute Ischemic Stroke in Chinese: The Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study.”1
We agree that the rate of patients receiving recombinant tissue plasminogen activator treatment is important. However, we do not agree with Chan’s statement that the main key in acute stoke management is time, not the dose of the recombinant tissue plasminogen activator. In fact, the purposes of our study were to compare the outcomes of thrombolytic therapy for acute ischemic stroke study in Taiwan with those of other studies in other countries and to study whether the low-dose therapy vs standard-dose therapy has similar outcomes in Chinese patients. Chan’s statement was about the topic of the percentage of Taiwan stroke patients receiving recombinant tissue plasminogen activator treatment, and it missed the whole point of our study.
Our study revealed that the standard-dose group had significantly higher rates of symptomatic intracerebral hemorrhage and mortality (twice that of those in the lower-dose group) and significantly lower independence rates compared with the lower-dose group, especially among patients 70 years of age and older.1 So, we emphasize that the appropriate dosage of alteplase for Chinese patients would result in a better outcomes, and determining the optimal dose of alteplase for Chinese patients is one of the most important issues in acute stroke management.
In all other countries, not just Taiwan, it is still possible to increase the percentage of patients receiving tissue plasminogen activator treatment.2 Like many organizations in other countries, the Taiwan stroke society has dedicated efforts to increase the rate of stroke patients receiving recombinant tissue plasminogen activator treatment over the past years and will continue to do so.
Chao AC, Hsu HY, Chung CP, Liu CH, Chen CH, Teng MM, Peng GS, Sheng WY, Hu HH; the Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group. Outcomes of Thrombolytic Therapy for Acute Ischemic Stroke in Chinese Patients. The Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study. Stroke. 2010; 41: 885–890.