Please use this identifier to cite or link to this item: https://doi.org/10.1177/1747493019858777
Title: Low-dose versus standard-dose alteplase in acute ischemic stroke in Asian stroke registries: an individual patient data pooling study
Authors: Wang, Xia
Li, Jingwei 
Moullaali, Tom J
Lee, Keon-Joo
Kim, Beom Joon
Bae, Hee-Joon
Wang, Anxin
Wang, Yilong
Wang, David Z
Wang, Yongjun
Kumamoto, Masaya
Toyoda, Kazunori
Koga, Masatoshi
Sato, Shoichiro
Yoshimura, Sohei
Sui, Yi
Xu, Bing
Xiao, Ying
Lee, Tsong-Hai
Liou, Chia-Wei
Lee, Jiann-Der
Peng, Tsung-
Huang, Yen-Chu
Paliwal, Prakash R 
Sharma, Manasi 
Escabillas, Cyrus
Navarro, Jose C
Sun, Mu-Chien
Dong, Yi
Dong, Qiang
Anderson, Craig S
Sharma, Vijay K 
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Peripheral Vascular Disease
Neurosciences & Neurology
Cardiovascular System & Cardiology
Acute ischemic stroke
thrombolysis
alteplase dose
symptomatic intracranial hemorrhage
individual patient analysis
Asian
TISSUE-PLASMINOGEN ACTIVATOR
MG/KG INTRAVENOUS ALTEPLASE
SAFE IMPLEMENTATION
THROMBOLYSIS STROKE
ENHANCED CONTROL
CONTROLLED-TRIAL
MULTICENTER
HYPERTENSION
GUIDELINE
RATIONALE
Issue Date: 1-Oct-2019
Publisher: SAGE PUBLICATIONS LTD
Citation: Wang, Xia, Li, Jingwei, Moullaali, Tom J, Lee, Keon-Joo, Kim, Beom Joon, Bae, Hee-Joon, Wang, Anxin, Wang, Yilong, Wang, David Z, Wang, Yongjun, Kumamoto, Masaya, Toyoda, Kazunori, Koga, Masatoshi, Sato, Shoichiro, Yoshimura, Sohei, Sui, Yi, Xu, Bing, Xiao, Ying, Lee, Tsong-Hai, Liou, Chia-Wei, Lee, Jiann-Der, Peng, Tsung-, Huang, Yen-Chu, Paliwal, Prakash R, Sharma, Manasi, Escabillas, Cyrus, Navarro, Jose C, Sun, Mu-Chien, Dong, Yi, Dong, Qiang, Anderson, Craig S, Sharma, Vijay K (2019-10-01). Low-dose versus standard-dose alteplase in acute ischemic stroke in Asian stroke registries: an individual patient data pooling study. INTERNATIONAL JOURNAL OF STROKE 14 (7) : 670-677. ScholarBank@NUS Repository. https://doi.org/10.1177/1747493019858777
Abstract: Objective: To investigate the comparative efficacy and safety of the low-dose versus standard-dose alteplase using real-world acute stroke registry data from Asian countries. Methods: Individual participant data were obtained from nine acute stroke registries from China, Japan, Philippines, Singapore, South Korea, and Taiwan between 2005 and 2018. Inverse probability of treatment weight was used to remove baseline imbalances between those receiving low-dose versus standard-dose alteplase. The primary outcome was death or disability defined by modified Rankin Scale scores of 2 to 6 at 90 days. Secondary outcomes were symptomatic intracerebral hemorrhage and death. Generalized linear mixed models with the individual registry as a random intercept were performed to determine associations of treatment with low-dose alteplase and outcomes. Results: Of the 6250 patients (mean age 66 years, 36% women) included in these analyses, 1610 (24%) were treated with low-dose intravenous alteplase. Clinical outcomes for low-dose alteplase were not significantly different to those for standard-dose alteplase, adjusted odds ratios for death or disability: 1.00 (0.85–1.19) and symptomatic intracerebral hemorrhage 0.87 (0.63–1.19), except for lower death with borderline significance, 0.77 (0.59–1.01). Conclusions: The present analyses of real-world Asian acute stroke registry data suggest that low-dose intravenous alteplase has overall comparable efficacy for functional recovery and greater potential safety in terms of reduced mortality, to standard-dose alteplase for the treatment of acute ischemic stroke.
Source Title: INTERNATIONAL JOURNAL OF STROKE
URI: https://scholarbank.nus.edu.sg/handle/10635/192299
ISSN: 17474930
17474949
DOI: 10.1177/1747493019858777
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