Low versus standard dose intravenous alteplase in the treatment of acute ischemic stroke in Egyptian patients

Abstract

‫يوم‬ 90 ‫في‬ ‫إيجابية‬ ‫(العدد=2)‬ 5% ‫ا‬ ً ‫يوم‬ 90 ‫ملدة‬ ‫الوفيات‬ ‫معدل‬ ‫كان‬ .)p=0.631( ‫الثانية‬ ‫الثانية‬ ‫املجموعة‬ ‫في‬ ‫(العدد=1)‬ 2.5% ‫مقابل‬ ‫األولى‬ ‫املجموعة‬ ‫في‬ ‫في‬ ‫مرضى‬ 3 ‫في‬ ‫اجلمجمة‬ ‫داخل‬ ‫نزيف‬ ‫أعراض‬ ‫وحظ‬ ٌ ‫ل‬ .)p=0.556( .)p=0.077( ‫األولى‬ ‫املجموعة‬ ‫في‬ ‫وصفر‬ ‫الثانية‬ ‫املجموعة‬ ‫ا‬ ً ‫عملي‬ ً ‫بديال‬ ‫تكون‬ ‫أن‬ ‫ميكن‬ ‫التيبالز‬ ‫من‬ ‫منخفضة‬ ‫جرعة‬ ‫اخلالصة:‬ ‫فترة‬ ‫في‬ ‫خاصة‬ ‫احلادة‬ ‫الدماغية‬ ‫بالسكتة‬ ‫املصابني‬ ‫املصريني‬ ‫للسكان‬ ‫ساعات.‬ 4.5 ‫إلى‬ 3 ‫من‬ ‫تتراوح‬ Objectives: To assess low dose altepase outcome and safety in comparison with a standard-dose regimen for acute ischemic stroke treatment in Egyptian patients. Materials: An observational prospective cohort nonrandomized single blinded study was carried out during the period from November 2017 to December 2018. Eighty Egyptian acute ischemic stroke patients, all eligible for intravenous alteplase, were subdivided into 2 groups )40 patients in each group(. Patients were thrombolysed at a dose of 0.6 mg/kg in the first group Original Article and 0.9 mg/kg in the second group. Both groups were compared in regard to safety and outcome. Safety was expressed by the rate of symptomatic intracranial hemorrhage )SICH( and 3 months mortality, while outcome was expressed by favorable outcomes at three months )modified Rankin Scale ]mRS[ of 0 to 2(. Results: In the first group, 69.2% )n=27( achieved favorable outcomes at 90 days compared with 64.1% )n=25( in the second group )p=0.631(. Ninety-day mortality was 5% )n=2( in the first group versus 2.5% )n=1( in the second group )p=0.556(. Symptomatic intracranial hemorrhage was noted in 3 patients in the second group and zero patients in the first group )p=0.077(. Conclusion:Low-dose alteplase could be a practical alternative for Egyptian populations with acute ischemic stroke especially in 3 to 4.5 hours window.

Different Doses of Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: A Network Meta-Analysis

“…Finally, 18 studies were included in the qualitative synthesis ( 7 – 11 , 19 , 20 , 30 – 40 ). The doses of three studies ( 30 , 34 , 39 ) did not meet the design of the present study and one study ( 40 ) without specific data was excluded from the final quantitative analysis.…”

“…The doses of three studies ( 30 , 34 , 39 ) did not meet the design of the present study and one study ( 40 ) without specific data was excluded from the final quantitative analysis. Fourteen studies were included in the quantitative synthesis ( 7 – 11 , 19 , 20 , 31 – 33 , 35 – 38 ). Table 1 summarizes the characteristics of the 14 included studies.…”

“…However, in this meta-analysis, the low dose was defined as <0.75 mg/kg, and the standard dose was defined as >0.75 mg/kg. In addition, five new studies (7)(8)(9)(10)(11) were reported after this meta-analysis. Moreover, traditional meta-analysis is difficult to use to assess the effects of two or more interventions.…”

Comparison of Effectiveness and Safety of Low-Dose Versus Standard-Dose Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke: A Meta-Analysis

“…Sources: [13][14][15][16][17][18][19][20][21][22]24,[26][27] Mortality: in the present meta-analysis, a total of 15 studies were included that compared the risk of mortality between low-dose and standard-dose alteplase. The incidence of mortality was lower in the lowdose group (9.72%) compared to the high-dose group (11.24%; RR: 0.93, 95% CI: 0.83-1.04), as shown in Figure 3.…”

“…A 2017 meta-analysis involving 12 studies found no significant difference between low dose and standard dose of r-tPA in terms of mortality and favorable outcomes [12]. Since this meta-analysis, certain new studies have been conducted to compare the efficacy and safety of low doses and standard doses, including non-randomized studies [13] and retrospective cohorts conducted in different regions of the world [14][15][16].…”