J Stroke.
2018 Jan;20(1):131-139. 10.5853/jos.2017.01578.
Low- versus Standard-Dose Intravenous Alteplase in the Context of Bridging Therapy for Acute Ischemic Stroke: A Korean ENCHANTED Study
- Affiliations
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- 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jongskim@amc.seoul.kr
- 2Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
- 3Department of Neurology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Korea.
- 4Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
- 5Department of Neurology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
- 6Department of Neurology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
- 7Department of Neurology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
- 8Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- 9Department of Neurology, Chungnam National University School of Medicine, Daejeon, Korea.
- 10Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea.
- 11Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul Korea.
- 12Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
- 13Department of Cardiovascular Sciences and NIHR Biomedical Research Unit, University of Leicester, Leicester, UK.
- 14Westmead Clinical School, University of Sydney, Westmead, Australia.
- 15Sydney Medical School, University of Sydney, Sydney, Australia. canderson@georgeinstitute.org.au
- 16The George Institute for Global Health, University of New South Wales, Newtown, Australia.
- 17Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia.
- 18The George Institute China at Peking University Health Science Center, Beijing, China.
- KMID: 2424444
- DOI: http://doi.org/10.5853/jos.2017.01578
Abstract
- BACKGROUND AND PURPOSE
Following the positive results from recent trials on endovascular therapy (EVT), bridging therapy (intravenous alteplase plus EVT) is increasingly being used for the treatment of acute ischemic stroke. However, the optimal dose of intravenous alteplase remains unknown in centers where bridging therapy is actively performed. The optimal dose for eventual recanalization and positive clinical outcomes in patients receiving bridging therapy also remains unknown.
METHODS
In this prospective Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) sub-study, we explored the outcomes following treatment with two different doses (low- [0.6 mg/kg] or standard-dose [0.9 mg/kg]) of intravenous alteplase across 12 Korean centers where EVT is actively performed. The primary endpoint was a favorable outcome at 90 days (modified Rankin Scale scores 0 to 1). Secondary endpoints included symptomatic intracerebral hemorrhage (ICH) in all patients, and the recanalization rate and favorable outcome in patients who underwent cerebral angiography for EVT (ClinicalTrials.gov, number NCT01422616).
RESULTS
Of 351 patients, the primary outcome occurred in 46% of patients in both the standard-(80/173) and low-dose (81/178) groups (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.72 to 1.81; P=0.582), although ICHs tended to occur more frequently in the standard-dose group (8% vs. 3%, P=0.056). Of the 67 patients who underwent cerebral angiography, there was no significant difference in favorable functional outcome between the standard- and low-dose groups (39% vs. 21%; OR, 2.39; 95% CI, 0.73 to 7.78; P=0.149).
CONCLUSIONS
There was no difference in functional outcome between the patients receiving different doses of alteplase in centers actively performing bridging therapy.
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