Low- Versus Standard-Dose Alteplase in Patients on Prior Antiplatelet Therapy
| Autor: | Pablo M. Lavados, Jeyaraj D Pandian, Andrew M. Demchuk, Jong S. Kim, Thang H. Nguyen, Octavio M. Pontes-Neto, Ji-Guang Wang, Verónica V. Olavarría, Philip M.W. Bath, Tsong Hai Lee, Sheila Cristina Ouriques Martins, Vivek Sharma, Mark Woodward, G Donnan, Xia Wang, Craig S. Anderson, John Chalmers, Thompson G. Robinson, Stefano Ricci, Shoichiro Sato, Richard I. Lindley, Hisatomi Arima, Laurent Billot, Mark W Parsons, Joseph P. Broderick |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Severity of Illness Index Brain Ischemia law.invention 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Randomized controlled trial Modified Rankin Scale law Internal medicine Outcome Assessment Health Care medicine Humans Single-Blind Method Stroke Aged Cerebral Hemorrhage Aged 80 and over Advanced and Specialized Nursing Intracerebral hemorrhage business.industry Thrombolysis Odds ratio Middle Aged medicine.disease Surgery Tissue Plasminogen Activator Platelet aggregation inhibitor Female Neurology (clinical) Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors 030217 neurology & neurosurgery Fibrinolytic agent |
| Zdroj: | Stroke. 48:1877-1883 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.116.016274 |
| Popis: | Background and Purpose— Many patients receiving thrombolysis for acute ischemic stroke are on prior antiplatelet therapy (APT), which may increase symptomatic intracerebral hemorrhage risk. In a prespecified subgroup analysis, we report comparative effects of different doses of intravenous alteplase according to prior APT use among participants of the international multicenter ENCHANTED study (Enhanced Control of Hypertension and Thrombolysis Stroke Study). Methods— Among 3285 alteplase-treated patients (mean age, 66.6 years; 38% women) randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset, 752 (22.9%) reported prior APT use. Primary outcome at 90 days was the combined end point of death or disability (modified Rankin Scale [mRS] scores, 2–6). Other outcomes included mRS scores 3 to 6, ordinal mRS shift, and symptomatic intracerebral hemorrhage by various standard criteria. Results— There were no significant differences in outcome between patients with and without prior APT after adjustment for baseline characteristics and management factors during the first week; defined by mRS scores 2 to 6 (adjusted odds ratio [OR], 1.01; 95% confidence interval [CI], 0.81–1.26; P =0.953), 3 to 6 (OR, 0.95; 95% CI, 0.75–1.20; P =0.662), or ordinal mRS shift (OR, 1.03; 95% CI, 0.87–1.21; P =0.770). Alteplase-treated patients on prior APT had higher symptomatic intracerebral hemorrhage (OR, 1.82; 95% CI, 1.00–3.30; P =0.051) according to the safe implementation of thrombolysis in stroke-monitoring study definition. Although not significant ( P -trend, 0.053), low-dose alteplase tended to have better outcomes than standard-dose alteplase in those on prior APT compared with those not using APT (mRS scores of 2–6; OR, 0.84; 95% CI, 0.62–1.12 versus OR, 1.16; 95% CI, 0.99–1.36). Conclusions— Low-dose alteplase may improve outcomes in thrombolysis-treated acute ischemic stroke patients on prior APT, but this requires further evaluation in a randomized controlled trial. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01422616. |
| Databáze: | OpenAIRE |
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