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Neurology and Therapy
Published in: Neurology and Therapy 4/2023

Open Access 11-05-2023 | Stroke | ORIGINAL RESEARCH

Effect of Intravenous Thrombolytic Dose of Alteplase on Long-Term Prognosis in Patients with Acute Ischemic Stroke

Authors: Mingfeng Zhai, Shugang Cao, Jinwei Yang, Xiaoyan Cao, Zhong Dong, Wanyin Liu, Yongzhan Fu, Qiyue Guan, Yu Wang, Hongbo Liu

Published in: Neurology and Therapy | Issue 4/2023

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Abstract

Introduction

This study aimed to investigate the long-term prognostic effects of different alteplase doses on patients with acute ischemic stroke (AIS).

Methods

In this cohort study, we enrolled 501 patients with AIS treated with intravenous thrombolysis with alteplase, with the primary endpoint event of recurrence of ischemic stroke and the secondary endpoint event of death. The effects of different doses of alteplase on recurrence of ischemic stroke and death were analyzed using a Cox proportional risk model.

Results

Among 501 patients with AIS treated with thrombolysis, 295 patients (58.9%) and 206 patients (41.1%) were treated with low-dose and standard-dose alteplase, respectively. During the study period, 61 patients (12.2%) had a confirmed recurrence of ischemic stroke. Multivariate Cox proportional risk analysis showed that standard-dose alteplase thrombolysis (HR 0.511, 95% CI 0.288–0.905, P = 0.021) was significantly associated with a reduced risk of long-term recurrence of AIS, whereas atrial fibrillation was associated with an increased risk of long-term recurrence of AIS. Thirty-nine (7.8%) patients died during the study period. Multivariate Cox proportional risk analysis showed that age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and symptomatic steno-occlusion were associated with an increased long-term risk of death from AIS. The alteplase dose was not associated with the risk of death from AIS.

Conclusions

Standard-dose alteplase treatment reduced the risk of long-term recurrence of AIS after hospital discharge and the alteplase dose was not associated with the long-term risk of death from AIS.
Literature
1.
Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581–641.CrossRefPubMed
2.
Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51.
3.
Tsivgoulis G, Katsanos AH, Kadlecová P, et al. Intravenous thrombolysis for ischemic stroke in the golden hour: propensity-matched analysis from the SITS-EAST registry. J Neurol. 2017;264(5):912–20.CrossRefPubMed
4.
Zheng H, Yang Y, Chen H, et al. Thrombolysis with alteplase 3–4.5 hours after acute ischaemic stroke: the first multicentre, phase III trial in China. Stroke Vasc Neurol. 2020;5(3):285–90.
5.
Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke. 2006;37(7): 1810–15.
6.
Bandettini di Poggio M, Finocchi C, Brizzo F, et al. Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome. Neurol Sci. 2019;40(2):319–26.
7.
Sharma VK, Tsivgoulis G, Tan JH, et al. Feasibility and safety of intravenous thrombolysis in multiethnic Asian stroke patients in Singapore. J Stroke Cerebrovasc Dis. 2010;19(6):424–30.CrossRefPubMed
8.
Liao X, Wang Y, Pan Y, et al. Standard-dose intravenous tissue-type plasminogen activator for stroke is better than low doses. Stroke. 2014;45(8):2354–8.CrossRefPubMed
9.
Kim JS, Kim YJ, Lee KB, et al. Low-versus standard-dose Intravenous alteplase in the context of bridging therapy for acute ischemic stroke: a Korean ENCHANTED Study. J Stroke. 2018;20(1):131–9.CrossRefPubMedPubMedCentral
10.
Chen CH, Tang SC, Chen YW, et al. Effectiveness of standard-dose vs. low-dose alteplase for acute ischemic stroke within 3–4.5 h. Front Neurol. 2022;13:763963.
11.
Wang X, Robinson TG, Lee TH, et al. Low-dose vs standard-dose alteplase for patients with acute ischemic stroke: secondary analysis of the ENCHANTED randomized clinical trial. JAMA Neurol. 2017;74(11):1328–35.CrossRefPubMedPubMedCentral
12.
Anderson CS, Robinson T, Lindley RI, et al. Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke. N Engl J Med. 2016;374(24):2313–23.CrossRefPubMed
13.
Zhou Z, Delcourt C, Xia C, et al. Low-dose vs standard-dose alteplase in acute lacunar ischemic stroke: the ENCHANTED trial. Neurology. 2021;96(11):e1512–26.CrossRefPubMedPubMedCentral
14.
Chao AC, Han K, Lin SF, et al. Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: a multicenter prospective cohort study. J Neurol Sci. 2019;399:76–81.CrossRefPubMed
15.
Muruet W, Rudd A, Wolfe CDA, Douiri A. Long-term survival after intravenous thrombolysis for ischemic stroke: a propensity score-matched cohort with up to 10-year follow-up. Stroke. 2018;49(3):607–13.CrossRefPubMedPubMedCentral
16.
Yu AYX, Fang J, Kapral MK. One-year home-time and mortality after thrombolysis compared with nontreated patients in a propensity-matched analysis. Stroke. 2019;50(12):3488–93.CrossRefPubMed
17.
Gensicke H, Seiffge DJ, Polasek AE, et al. Long-term outcome in stroke patients treated with IV thrombolysis. Neurology. 2013;80(10):919–25.CrossRefPubMed
18.
Simpkins AN, Dias C, Norato G, Kim E, Leigh R, NIH Natural History of Stroke Investigators. Early change in stroke size performs best in predicting response to therapy. Cerebrovasc Dis. 2017;44(3–4):141–9.
19.
Terkelsen T, Schmitz ML, Simonsen CZ, et al. Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use: a nationwide propensity score-matched follow-up study. Int J Stroke. 2016;11(8):910–6.CrossRefPubMed
20.
Schmitz ML, Simonsen CZ, Hundborg H, et al. Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study. Stroke. 2014;45(10):3070–2.CrossRefPubMed
21.
Magalhães R, Abreu P, Correia M, Whiteley W, Silva MC, Sandercock P. Functional status three months after the first ischemic stroke is associated with long-term outcome: data from a community-based cohort. Cerebrovasc Dis. 2014;38(1):46–54.CrossRefPubMed
22.
Maier IL, Bauerle M, Kermer P, Helms HJ, Buettner T. Risk prediction of very early recurrence, death and progression after acute ischaemic stroke. Eur J Neurol. 2013;20(4):599–604.CrossRefPubMed
23.
24.
Yafasova A, Fosbøl EL, Johnsen SP, et al. Time to thrombolysis and long-term outcomes in patients with acute ischemic stroke: a nationwide study. Stroke. 2021;52(5):1724–32.CrossRefPubMed
25.
Man S, Xian Y, Holmes DN, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA. 2020;323(21):2170–84.CrossRefPubMedPubMedCentral
26.
Slot KB, Berge E, Dorman P, et al. Impact of functional status at six months on long term survival in patients with ischaemic stroke: prospective cohort studies. BMJ. 2008;336(7640):376–9.CrossRefPubMedPubMedCentral
27.
Kim MS, Joo MC, Sohn MK, et al. Impact of functional status on noncardioembolic ischemic stroke recurrence within 1 year: the Korean stroke cohort for functioning and rehabilitation study. J Clin Neurol. 2019;15(1):54–61.CrossRefPubMed
28.
McKevitt C, Coshall C, Tilling K, Wolfe C. Are there inequalities in the provision of stroke care? Analysis of an inner-city stroke register. Stroke. 2005;36(2):315–20.CrossRefPubMed
29.
Flach C, Muruet W, Wolfe CDA, Bhalla A, Douiri A. Risk and secondary prevention of stroke recurrence: a population-base cohort study. Stroke. 2020;51(8):2435–44.CrossRefPubMedPubMedCentral
30.
Seet RC, Zhang Y, Wijdicks EF, Rabinstein AA. Relationship between chronic atrial fibrillation and worse outcomes in stroke patients after intravenous thrombolysis. Arch Neurol. 2011;68(11):1454–8.CrossRefPubMed
31.
Huang WY, Weng WC, Su FC, Lin SW. Association between stroke severity and 5-year mortality in ischemic stroke patients with high-grade stenosis of internal carotid artery. J Stroke Cerebrovasc Dis. 2018;27(11):3365–72.CrossRefPubMed
32.
Andersen KK, Andersen ZJ, Olsen TS. Predictors of early and late case-fatality in a nationwide Danish study of 26,818 patients with first-ever ischemic stroke. Stroke. 2011;42(10):2806–12.CrossRefPubMed
33.
Bryndziar T, Matyskova D, Sedova P, et al. Predictors of short- and long-term mortality in ischemic stroke: a community-based study in Brno, Czech Republic. Cerebrovasc Dis. 2022;51(3):296–303.CrossRefPubMed
Metadata
Title
Effect of Intravenous Thrombolytic Dose of Alteplase on Long-Term Prognosis in Patients with Acute Ischemic Stroke
Authors
Mingfeng Zhai
Shugang Cao
Jinwei Yang
Xiaoyan Cao
Zhong Dong
Wanyin Liu
Yongzhan Fu
Qiyue Guan
Yu Wang
Hongbo Liu
Publication date
11-05-2023
Publisher
Springer Healthcare
Published in
Neurology and Therapy / Issue 4/2023
Print ISSN: 2193-8253
Electronic ISSN: 2193-6536
DOI
https://doi.org/10.1007/s40120-023-00488-3

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