A-Ching Chao1, Ke Han2, Sheng-Feng Lin3, Ruey-Tay Lin1, Chih-Hung Chen4, Lung Chan5, Huey-Juan Lin6, Yu Sun7, Yung-Yang Lin8, Po-Lin Chen9, Shinn-Kuang Lin10, Cheng-Yu Wei11, Yu-Te Lin12, Jiunn-Tay Lee13, Han-Hwa Hu14, Chyi-Huey Bai15. 1. Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. 2. Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong Province, China. 3. School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Clinical Pathology, Far Eastern Memorial Hospital, Taipei, Taiwan. 4. Neurology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan. 5. Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan. 6. Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan. 7. Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan. 8. Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan. 9. Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan. 10. Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan. 11. Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan. 12. Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. 13. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 14. Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cerebrovascular Disease Treatment and Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: hanhwa@hotmail.com. 15. School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: baich@tmu.edu.tw.
Abstract
BACKGROUND AND PURPOSE: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. METHODS: The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24-36 h of intravenous alteplase were measured. The baseline NIHSS of 4-8, 9-13, ≥14 were defined as mild, moderate, and high severity, respectively. RESULTS: Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). CONCLUSIONS: Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.
BACKGROUND AND PURPOSE: The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric strokepatients. METHODS: The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24-36 h of intravenous alteplase were measured. The baseline NIHSS of 4-8, 9-13, ≥14 were defined as mild, moderate, and high severity, respectively. RESULTS: Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). CONCLUSIONS: Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.
Authors: Ahmed O Idowu; Ahmad A Sanusi; Simon A Balogun; Christopher O Anele; Akintunde A Adebowale; Abdulmajeed K Abidoye; Gloria J Akinola; Michael B Fawale; Morenikeji A Komolafe Journal: Cureus Date: 2022-06-16