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Neurocritical Care

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01-08-2014 | Original Article

A Critical Analysis of Intra-arterial Thrombolytic Doses in Acute Ischemic Stroke Treatment

Authors: Ameer E. Hassan, Foad Abd-Allah, Saqib A. Chaudhry, Malik M. Adil, Nassir Rostambeigi, Adnan I. Qureshi

Published in: Neurocritical Care | Issue 1/2014

Abstract

Background

Intra-arterial thrombolytics (IAT) such as Alteplase, Tenecteplase, and Reteplase are currently used in patients with acute ischemic stroke in varying doses. We evaluated the relationship of IA thrombolytic dose with angiographic recanalization, intracerebral hemorrhage (ICH) rates, and clinical outcomes at three comprehensive stroke centers.

Methods

We stratified patients who underwent endovascular treatment into tertiles based on intra-arterial thrombolytic dose administered: lower tertile (range 1.5–5 mg), middle tertile (range 6–10 mg), and upper tertile (range 10.3–68.5 mg) of rt-PA equivalent. The rates of angiographic recanalization, ICH, and favorable clinical outcomes (discharge modified Rankin score [mRS] = 0–2) were ascertained and compared within the three tertiles. Logistic regression analyses were performed to determine the association between IA thrombolytic dosages and angiographic recanalization, ICH, and favorable clinical outcomes after adjusting for potential confounders.

Results

A total of 197 patients were treated with IAT; mean age ±SD was 65.6 ± 16 years; 105 (53.3 %) were women. Ninety-one (46.2 %) patients received both IVT and IAT. IA rt-PA equivalent dose was not different between the patients with and without ICH [mean (mg) ± SD, 9.8 ± 6.1 versus 9.8 ± 9.5, p = 0.9]. We did not find any relation between increasing doses of IAT (from 2 to 69 mg rt-PA equivalent) and symptomatic or asymptomatic ICH: (p = 0.1630) and (p = 0.6702), respectively. Multivariate analysis demonstrated that IAT dose was not associated with ICH (OR 1.0, 95 % CI 0.97–1.07, p = 0.3919) or favorable outcome (OR, 1.00, 95 % CI 0.95–1.06, p = 0.7375). In a subset analysis of IVT patients, total doses ranged from 48.2 to 149 mg and were not associated with either symptomatic (p = 0.23) or asymptomatic (p = 0.24) ICHs.

Conclusion

Our study demonstrates that IAT in doses up to 69 mg is safe without any evidence of dose-related ICHs even in those patients who had received IVT.

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Title: A Critical Analysis of Intra-arterial Thrombolytic Doses in Acute Ischemic Stroke Treatment
Authors: Ameer E. Hassan
Foad Abd-Allah
Saqib A. Chaudhry
Malik M. Adil
Nassir Rostambeigi
Adnan I. Qureshi
Publication date: 01-08-2014
Publisher: Springer US
Published in: Neurocritical Care / Issue 1/2014
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-013-9859-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A Critical Analysis of Intra-arterial Thrombolytic Doses in Acute Ischemic Stroke Treatment

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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