Comparison of Standard and Reduced Dose rt-PA in Ischemic Stroke Patients

Abstract

Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending on ethnicity, one reason that few Eastern countries have approved a lower dose of alteplase. Data in this regard are scarce in the Middle Eastern region. Patients and Methods: The present retrospective study was performed on data extracted from the SITS registry. CT image analysis was based on the SITS-MOST definition for symptomatic intracranial hemorrhage (SICH). Functional outcome at 3 months was assessed using the modified Rankin Scale. Multivariate logistic regression including adjusted analysis was used for comparison between groups. Results: Of 6,615 patients, 1,055 were enrolled. A total of 86% (906) received a standard dose and 14% (149) received a low dose of alteplase. Favorable 3-month outcome was achieved in 481 (53%) patients in the standard group and in 71 (48%) patients in the low-dose group (adjusted OR = 1.24, 95% CI 0.879-1.75, p = 0.218). SICH occurred in 14 (1.5%) patients in the standard group and in 3 (2%) patients in the low-dose group (OR = 2.77, CI 95% 0.365-21.04, p = 0.12). At 3 months, mortality occurred in 145 (16%) patients in the standard group and in 29 (19.4%) patients in the low-dose group (OR = 1.22, CI 95% 0.788-1.916, p = 0.346).