Efficacy and safety of low dose alteplase for intravenous thrombolysis in Asian stroke patients: a meta-analysis

Abstract

Whether low dose alteplase is comparable to standard dose in efficacy and safety for intravenous thrombolysis (IVT) in Asian stroke patients remains unverified. PubMed, EMBASE, and Cochrane Library Database from the beginning to June 30, 2017 were searched. IVT efficacy was measured by favorable outcome (modified Rankin Scale scores of 0–1) at 3 months, and safety measured by mortality within 3 months and symptomatic intracerebral hemorrhage (SICH). Pooled estimates were conducted using fixed- or random-effects model depending on heterogeneity. For SICH, studies were pooled separately according to different definitions. Twelve studies involving 7,905 participants were included. No association was found between alteplase dose and favorable outcome (OR = 0.94, 95% CI 0.78–1.14, P = 0.5; heterogeneity: P hetero = 0.01, I2 = 57.3%) and mortality (OR = 0.87, 95% CI 0.74–1.02, P = 0.08; P hetero = 0.83, I2 = 0) using random- and fixed-effects models, respectively. Low dose alteplase was associated with lower SICH as defined by the National Institute of Neurological Disorders and Stroke study (OR = 0.79, 95% CI 0.64–0.99, P = 0.04; P hetero = 0.57, I2 = 0) using fixed-effects model. Subgroup and sensitivity analysis could change the results significantly. Current limited evidence was insufficient to support the speculation that low dose alteplase was comparable to standard dose in thrombolytic efficacy and safety in Asian stroke patients.

Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country

“…Supplementary Table 3 illustrates studies comparing low dose vs standard dose which mostly shows no difference for efficacy outcomes. A previous meta-analysis had concluded that there is no association between alteplase dose and favourable outcome and mortality, but that the low dose may be associated with a lower incidence of sICH [ 33 ]. From a cost perspective, alteplase used in Sri Lanka is made in India and a 20 mg vial costs USD 355 while a 50 mg vial costs USD 692.…”

Outcomes of Stroke Patients Undergoing Thrombolysis in Sri Lanka; an Observational Prospective Study From a Low-middle Income Country

“…Supplementary table 3 illustrates studies comparing low dose vs standard dose which mostly shows no difference for e cacy and safety outcomes. A previous meta-analysis had concluded that there is no association between alteplase dose and favourable outcome and mortality, but that the low dose may be associated with a lower incidence of sICH 44 . From a cost perspective, alteplase used in Sri Lanka is made in India and a 20 mg vial costs USD 355 while a 50 mg vial costs USD 692.…”

Risk Factors Associated with Prognosis in Patients with Acute Stroke: A Retrospective Observational Study

“…The early treatment of the thrombolytic after ischemic stroke (best time: 3-4.5 h) leads to the improvement of the positive effects of treatment and disability induced by the ischemic stroke (19). According to the literature, it is necessary to monitor the patient precisely from the injection to at least 48 h after treatment to reduce the side effects of TPA injection (16)(17)(18)(19)(20).…”