Is Low Dose of Rt-PA Treatment Effective in Acute Ischemic Stroke? A Comparison Study with the Standard Dose
Vorasoot N, MD1,2, Boonpayak S, MD1,2 , Kongbunkiat K, MD1,2, Kasemsap N, MD1,2, Tiamkao S, MD1,2, Sawanyawisuth K, MD, PhD1,3
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand 2 North-Eastern Stroke Research Group, Khon Kaen University, Khon Kaen, Thailand 3 Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Research and Training Center for Enhancing Quality of Life of Working Age People and Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
A recombinant tissue plasminogen activator (rt-PA) treatment is effective in acute ischemic stroke. Treatment dosage of the rt-PA in Asian populations is still debating. The present study therefore aimed to evaluate the efficacy and side effects of the low dose treatment of rt-PA in Thai acute ischemic stroke patients compared with the standard dose. The authors conducted a multicenter descriptive retrospective analytical study in three hospitals in northeastern, Thailand. The inclusion criteria were acute ischemic stroke patients registered in the Stroke Fast Track treatment for those over the age over 18 years and received the rt-PA treatment. All eligible patients were divided into two groups by dose of rt-PA treatment; low dose with 0.6 mg/kg of rt-PA and standard dose or 0.9 mg/kg. Baseline characteristics and stroke outcomes of all patients were recorded. The stroke outcomes included the NIH Stroke Scale (NIHSS), side effects of rt-PA, and deaths. There were 371 patients met the study criteria and categorized as low dose group for 117 patients (31.54%) and standard dose group for 254 patients (68.46%). The low dose group had older age (67.5 vs. 60.1 years), higher proportions of atrial fibrillation (23.1% vs. 11.8%), and baseline NIHSS (12 vs. 9) than the standard dose group. Regarding outcomes or complications, there was no significant different of any outcomes between both groups such as NIHSS improvement, intracerebral hemorrhage, or mortality. In conclusion, the low dose of rt-PA treatment for acute ischemic stroke may be justified particularly those with older age or more severe stroke.
Keywords : Age, Atrial fibrillation, NIHSS
