Min Lou1, Magdy Selim. 1. The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Abstract
BACKGROUND: The recommended dose of IV tissue plasminogen activator (t-PA) for ischemic stroke patients weighing >100 kg (ISPW >100 kg) is fixed at 90 mg. Elevated levels of plasminogen activator inhibitor-1 (PAI-1) and impaired fibrinolysis have been reported in heavy patients, suggesting that ISPW >100 kg may require higher doses of t-PA. We hypothesized that ISPW >100 kg are less likely to benefit from IV t-PA compared to patients who weigh <or=100 kg and receive a weight-based dose. METHODS: We queried the National Institute of Neurological Disorders and Stroke t-PA study database, and performed multivariate logistic regression analyses to analyze the effects of weight (>100 vs. <or=100 kg) and t-PA dose on functional outcomes at 3 months. RESULTS: Six percent of the t-PA and 10% of the placebo cohorts had an actual body weight >100 kg. Weight >100 kg emerged as a predictor of worse outcome (OR = 5.76; p = 0.017) and neurological deterioration (OR = 3.4; p = 0.07) after t-PA. This negative impact of body weight on outcome was not seen among placebo-treated patients. We also found a trend for an association between lower doses of t-PA and unfavorable 3-month outcomes in t-PA-treated patients (OR = 1.9; p = 0.05). CONCLUSIONS: ISPW >100 kg seem to derive less benefit from IV t-PA than their lighter counterparts. This may be partly attributed to the use of fixed non-weight-adjusted dosing in heavier patients. The mechanism(s) underlying this observation and its potential therapeutic implications require further investigations. Copyright 2008 S. Karger AG, Basel.
RCT Entities:
BACKGROUND: The recommended dose of IV tissue plasminogen activator (t-PA) for ischemic strokepatients weighing >100 kg (ISPW >100 kg) is fixed at 90 mg. Elevated levels of plasminogen activator inhibitor-1 (PAI-1) and impaired fibrinolysis have been reported in heavy patients, suggesting that ISPW >100 kg may require higher doses of t-PA. We hypothesized that ISPW >100 kg are less likely to benefit from IV t-PA compared to patients who weigh <or=100 kg and receive a weight-based dose. METHODS: We queried the National Institute of Neurological Disorders and Stroket-PA study database, and performed multivariate logistic regression analyses to analyze the effects of weight (>100 vs. <or=100 kg) and t-PA dose on functional outcomes at 3 months. RESULTS: Six percent of the t-PA and 10% of the placebo cohorts had an actual body weight >100 kg. Weight >100 kg emerged as a predictor of worse outcome (OR = 5.76; p = 0.017) and neurological deterioration (OR = 3.4; p = 0.07) after t-PA. This negative impact of body weight on outcome was not seen among placebo-treated patients. We also found a trend for an association between lower doses of t-PA and unfavorable 3-month outcomes in t-PA-treated patients (OR = 1.9; p = 0.05). CONCLUSIONS: ISPW >100 kg seem to derive less benefit from IV t-PA than their lighter counterparts. This may be partly attributed to the use of fixed non-weight-adjusted dosing in heavier patients. The mechanism(s) underlying this observation and its potential therapeutic implications require further investigations. Copyright 2008 S. Karger AG, Basel.
Authors: T G Kwiatkowski; R B Libman; M Frankel; B C Tilley; L B Morgenstern; M Lu; J P Broderick; C A Lewandowski; J R Marler; S R Levine; T Brott Journal: N Engl J Med Date: 1999-06-10 Impact factor: 91.245
Authors: D L Crandall; E M Quinet; G A Morgan; D E Busler; B McHendry-Rinde; J G Kral Journal: J Clin Endocrinol Metab Date: 1999-09 Impact factor: 5.958