Title:Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients Receiving Thrombectomy: Standard or Low Dose Therapy?
Volume: 15
Issue: 3
Author(s): Chun-Hsien Lin, Chi-Hung Liu, Alvin Yi-Chou Wang, Yi-Ming Wu, Ching-Chang Chen, Yuan-Hsiung Tsai, Ting-Yu Chang, Kuo-Lun Huang, Hsiu-Chuan Wu, Tsong-Hai Lee, Yeu-Jhy Chang, Chuan-Min Lin, Chih-Kuang Cheng and Chien-Hung Chang*
Affiliation:
- College of Medicine, Chang Gung University, Taoyuan,Taiwan
Keywords:
Acute ischemic stroke, acute stroke therapy, dose, mechanical thrombectomy, tissue plasminogen activator, large
vessel occlusions.
Abstract: Background: We compared the clinical outcomes of low and standard dose recombinant
tissue Plasminogen Activator (rtPA) treatment in Acute Ischemic Stroke (AIS) patients receiving
Endovascular Mechanical Thrombectomy (EVT).
Methods: Between April 01, 2015 and September 30, 2017, all AIS patients admitted to the Linkou
and Chiayi Chang Gung Memorial Hospital were retrospectively reviewed. Patients with large
vessel occlusions, who underwent bridging therapy with rtPA and EVT, were further enrolled. The
enrolled patients were categorized into low (0.6-0.7 mg/kg; LD) or standard dose (0.9 mg/kg; SD)
group based on the dose of rtPA they received. Baseline characteristics, reperfusion status, and
clinical outcomes were compared between the two groups.
Results: Forty-two patients were enrolled in the final analyses, including 13 in the LD and 29 in
the SD group. In all groups analyzed, the frequencies of moderate to severe and severe stroke at
discharge were significantly decreased compared to those at stroke onset (p < 0.01). Compared to
the SD group, patients of the LD group had a similar rate of mortality (LD vs. SD; 0% vs. 3.4%, p
= 1.00), and comparable frequencies of functional independence at 3 months after stroke onset (LD
vs. SD; 33.3% vs. 44.8%, p = 0.50). The rates of symptomatic intracerebral hemorrhage were also
similar between the two groups (LD vs. SD; 0% vs. 6.9%, p =1.00).
Conclusions: Compared to standard dose treatment, low dose rtPA may have similar clinical efficacy
and safety outcomes in AIS patients receiving bridging therapy.
