Low dosis of alteplase, for ischemic stroke after Enchanted and its determinants, a single center experience

Abstract Background: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient's age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37‒14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98‒32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81‒357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37‒14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10‒0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs.

Subjects

acute stroke

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therapeutic thrombolysis

;

thrombolytic therapy

;

aged

;

aged, 80 and over

;

brain ischemia

;

female

;

fibrinolytic agents

;

humans

;

ischemic stroke

;

male

;

middle aged

;

prospective studies

;

stroke

;

thrombolytic therapy

;

tissue plasminogen activator

;

treatment outcome

;

alteplase

;

fibrinolytic agent

;

tissue plasminogen activator

;

adult

;

aged

;

article

;

atrial fibrillation

;

brain ischemia

;

computer assisted tomography

;

controlled study

;

coronary artery disease

;

diabetes mellitus

;

diastolic blood pressure

;

diffusion weighted imaging

;

dual antiplatelet therapy

;

female

;

human

;

hypercholesterolemia

;

hypertension

;

leukoaraiosis

;

low drug dose

;

magnetic resonance angiography

;

major clinical study

;

male

;

neuroimaging

;

nuclear magnetic resonance imaging

;

platelet count

;

smoking

;

systolic blood pressure

;

adverse event

;

cerebrovascular accident

;

fibrinolytic therapy

;

middle aged

;

prospective study

;

treatment outcome

;

very elderly