Abstract W P58: Low Dose Versus Standard Dose Alteplase For Acute Ischemic Stroke Patients Within 4.5 Hours From Onset: A Comparative Effectiveness And Safety Study
Background: 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 the concurrent standard-dose (0.9 mg/Kg) regimen. The aim of the current study was to investigate the comparative effectiveness and safety of low-dose alteplase treatment against standard dose regimen.
Methods: A total of 1572 acute ischemic stroke patients who arrived within 4.5 hours from their last seen normal and treated with alteplase between November 2009 and March 2013 were identified from a prospective, multicenter and nationwide stroke registry database containing 15814 case records. Acute stroke management including the decision on the dose of alteplase was performed according to the current guideline and the attending physicians’ discretion. Inverse probability of low-dose strategy weighting (IPTW) by the propensity score was primarily utilized to remove baseline imbalance between the two doses.
Results: From a total of 1572 cases who met the eligibility criteria, low-dose alteplase was infused in 464 (29.5%) subjects and standard-dose in 1108 (70.5%) cases. Low-dose group showed shorter onset-to-arrival delay, higher NIHSS score at arrival, and more frequent endovascular treatment. The balance between alteplase doses were adequately balanced using IPTW technique, and the low-dose alteplase treatment was not associated with a mRS score of 0 - 1 at 3 months and with symptomatic HT or 3-month mortality (see Figure A). When the analyses were limited to the subgroup without endovascular treatment, the neutral associations with mRS score 0 - 1 and symptomatic HT were retained but the odds for 3-month mortality was significantly lower in the low-dose alteplase group (see Figure B).
Conclusion: The low-dose alteplase strategy was as comparable as the standard-dose treatment in terms of the effectiveness and safety, also with possibly decreasing 3-month mortality.
Author Disclosures: B. Kim: None. M. Han: None. T. Park: None. S. Park: None. K. Lee: None. B. Lee: None. K. Yu: None. M. Oh: None. J. Cha: None. D. Kim: None. J. Lee: None. S. Lee: None. Y. Ko: None. J. Park: None. K. Kang: None. Y. Cho: None. K. Hong: None. J. Kim: None. J. Choi: None. D. Kim: None. D. Shin: None. W. Kim: None. J. Lee: None. J. Lee: None. B. Yoon: None. H. Bae: None.
- © 2015 by American Heart Association, Inc.