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Low-dose vs. standard-dose intravenous alteplase in bridging therapy among patients with acute ischemic stroke: Experience from a stroke center in Vietnam

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Mai, DT, Dao, VP, Nguyen, VC, Vu, DL, Nguyen, TD, Vuong, XT, Bui, QV, Phan, HQ, Pham, QT, Le, HK, Tran, AT, Nguyen, QA, Dang, PD, Nguyen, H ORCID: 0000-0003-4281-5948 and Phan, HT ORCID: 0000-0003-0506-2924 2021 , 'Low-dose vs. standard-dose intravenous alteplase in bridging therapy among patients with acute ischemic stroke: Experience from a stroke center in Vietnam' , Frontiers in Neurology , pp. 1-8 , doi: 10.3389/fneur.2021.653820.

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Abstract

Background: To date, the role of bridging intravenous thrombolysis before mechanicalthrombectomy (MTE) is controversial but still recommended in eligible patients. Differentdoses of intravenous alteplase have been used for treating patients with acute ischemicstroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risksfor intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over thepotential benefits of treating low-dose alteplase, as opposed to standard-dose alteplase,prior to MTE among patients with LVO-AIS.Aim: The aim of the study was to compare outcomes of low- vs. standard-dose ofbridging intravenous alteplase before MTE among LVO-AIS patients.Methods: We performed a retrospective analysis of LVO-AIS patients who were treatedwith either 0.6 mg/kg or 0.9 mg/kg alteplase prior to MTE at a stroke center in NorthernVietnam. Multivariable logistic regression models, accounting for potential confoundingfactors including comorbidities and clinical factors (e.g., stroke severity), were used tocompare the outcomes between the two groups. Our primary outcome was functionalindependence at 90 days following stroke (modified Rankin score; mRS ≤ 2). Secondaryoutcomes included any ICH incidence, early neurological improvement, recanalizationrate, and 90-day mortality.Results: We analyzed data of 107 patients receiving bridging therapy, including 73 withlow-dose and 34 with standard-dose alteplase before MTE. There were no statisticallysignificant differences between the two groups in functional independence at 90 days(adjusted OR 1.02, 95% CI 0.29–3.52) after accounting for potential confounding factors.Compared to the standard-dose group, patients with low-dose alteplase before MTEhad similar rates of successful recanalization, early neurological improvement, 90-daymortality, and ICH complications.Conclusion: In the present study, patients with low-dose alteplase before MTE werefound to achieve comparable clinical outcomes compared to those receiving standarddose alteplase bridging with MTE. The findings suggest potential benefits of low-dosealteplase in bridging therapy for Asian populations, but this needs to be confirmed byfurther clinical trials.

Item Type: Article
Authors/Creators:Mai, DT and Dao, VP and Nguyen, VC and Vu, DL and Nguyen, TD and Vuong, XT and Bui, QV and Phan, HQ and Pham, QT and Le, HK and Tran, AT and Nguyen, QA and Dang, PD and Nguyen, H and Phan, HT
Keywords: stroke, intravenous thrombolysis, bridging therapy, outcome, dose
Journal or Publication Title: Frontiers in Neurology
Publisher: Frontiers Research Foundation
ISSN: 1664-2295
DOI / ID Number: 10.3389/fneur.2021.653820
Copyright Information:

Copyright 2021 Mai, Dao, Nguyen, Vu, Nguyen, Vuong, Bui, Phan, Pham, Le,Tran, Nguyen, Dang, Nguyen and Phan. This is an open-access article distributedunder the terms of the Creative Commons Attribution License (CC BY)

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