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Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients Receiving Thrombectomy: Standard or Low Dose Therapy?

[ Vol. 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*   Pages 204 - 210 ( 7 )

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.

Keywords:

Acute ischemic stroke, acute stroke therapy, dose, mechanical thrombectomy, tissue plasminogen activator, large vessel occlusions.

Affiliation:

Department of Neurology, Chang Gung Memorial Hospital, Chiayi, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, College of Medicine, Chang Gung University, Taoyuan, Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, College of Medicine, Chang Gung University, Taoyuan



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