Determinants for a low dose of alteplase and its relationship to a lower intracerebral bleeding risk in acute ischemic stroke

Chen, Jie; Li, Hangfeng; Lei, Hanhan; Fang, Shuangfang; Yuan, Qilin; Chen, Yangui; Chen, Dongping; Chen, Ronghua; Zhang, Yixian; Wei, Jin; Chen, Guangliang; Chen, Zhiting; Liu, Nan; Du, Hou-wei

doi:10.7150/ijms.76105

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Int J Med Sci 2022; 19(12):1762-1769. doi:10.7150/ijms.76105 This issue Cite

Research Paper

Determinants for a low dose of alteplase and its relationship to a lower intracerebral bleeding risk in acute ischemic stroke

Jie Chen, M.D.^1#, Hangfeng Li, M.D.^2#, Hanhan Lei, M.D.³, Shuangfang Fang, M.D.³, Qilin Yuan, M.D.^3,4, Yangui Chen, M.D.¹, Dongping Chen, M.D.¹, Ronghua Chen, M.D.^3,4, Yixian Zhang, M.D.⁵, Jin Wei, M.D.⁶, Guangliang Chen, M.D.⁶, Zhiting Chen, M.D.^3,4, Nan Liu, M.D.^3,5, Hou-wei Du, M.D.^3,4✉

1. Department of Neurology, Fujian Provincial Hospital South Branch, Fuzhou, China.
2. Department of Neurology, Longyan First Hospital of Fujian Medical University, Longyan, Fujian, China.
3. Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China.
4. Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China.
5. Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China.
6. Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
#These first two authors have contributed equally to this work.

Citation:

Chen J, Li H, Lei H, Fang S, Yuan Q, Chen Y, Chen D, Chen R, Zhang Y, Wei J, Chen G, Chen Z, Liu N, Du Hw. Determinants for a low dose of alteplase and its relationship to a lower intracerebral bleeding risk in acute ischemic stroke. Int J Med Sci 2022; 19(12):1762-1769. doi:10.7150/ijms.76105. https://www.medsci.org/v19p1762.htm

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Abstract

Background: Factors for the utilization of intravenous thrombolysis with a low-dose of alteplase (0.6mg/kg) and whether the low-dose of alteplase could reduce the risk of intracerebral bleeding in acute ischemic stroke (AIS) remains uncertain.

Aims: We aimed to investigate determinants for the utilization of intravenous thrombolysis with a low-dose of alteplase. We further assessed the association between the low-dose of alteplase and the intracerebral bleeding risk in AIS patients.

Method: We included AIS patients who received intravenous thrombolysis using alteplase in this multicenter retrospective observational study. We investigated the association between baseline characteristics and the utilization of a low-dose of alteplase to identify determinants. We assessed the association of the low-dose of alteplase with the risk of symptomatic intracranial hemorrhage (sICH) using a multivariable logistic regression model. We further compared the rate of sICH and any ICH in patients in the low-dose group to those in the standard-dose group, using propensity score-matching data.

Results: A total of 506 AIS patients were included in this study. The mean age was 67 (interquartile range [IQR] 59-75), and 178 (35.2%) were women. A total of 96 patients were treated with the low-dose. Age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.00 -1.04, p = 0.042), having a previous ischemic stroke (adjusted OR 2.01, 95%CI 1.11 - 3.64 p = 0.021) and increasing baseline systolic blood pressure (adjusted OR 1.12, 95%CI 1.00 - 1.26, p = 0.049) were determinants for the utilization of the low-dose. Multivariable logistic regression analysis showed that the low-dose was significantly associated with a reduced risk of sICH (adjusted OR 0.13, 95%CI 0.03 - 0.62, p = 0.01). Propensity score analysis showed that the rate of sICH was significantly lower in the low-dose group compared to standard-dose group (2 [2.3%] vs 10 [11.4%], p = 0.032). There was no significant difference in the rate of any ICH between two groups (14 [15.9%] vs 18 [20.5%], p = 0.434).

Conclusions: Patients with increasing age, a higher baseline systolic blood pressure, and previous ischemic stroke were at a higher odd of receiving a low-dose of alteplase. The low-dose was associated with a lower risk of developing symptomatic intracranial hemorrhage.

Keywords: acute ischemic stroke, low-dose, alteplase, symptomatic intracranial hemorrhage

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APA

Chen, J., Li, H., Lei, H., Fang, S., Yuan, Q., Chen, Y., Chen, D., Chen, R., Zhang, Y., Wei, J., Chen, G., Chen, Z., Liu, N., Du, H.w. (2022). Determinants for a low dose of alteplase and its relationship to a lower intracerebral bleeding risk in acute ischemic stroke. International Journal of Medical Sciences, 19(12), 1762-1769. https://doi.org/10.7150/ijms.76105.

ACS

Chen, J.; Li, H.; Lei, H.; Fang, S.; Yuan, Q.; Chen, Y.; Chen, D.; Chen, R.; Zhang, Y.; Wei, J.; Chen, G.; Chen, Z.; Liu, N.; Du, H.w. Determinants for a low dose of alteplase and its relationship to a lower intracerebral bleeding risk in acute ischemic stroke. Int. J. Med. Sci. 2022, 19 (12), 1762-1769. DOI: 10.7150/ijms.76105.

NLM

CSE

Chen J, Li H, Lei H, Fang S, Yuan Q, Chen Y, Chen D, Chen R, Zhang Y, Wei J, Chen G, Chen Z, Liu N, Du Hw. 2022. Determinants for a low dose of alteplase and its relationship to a lower intracerebral bleeding risk in acute ischemic stroke. Int J Med Sci. 19(12):1762-1769.

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