Outcomes of Thrombolytic Therapy for Acute Ischemic Stroke in Chinese Patients

Chao, A-Ching; Hsu, Hung‐Yi; Chung, Chih‐Ping; Liu, Chung‐Hsiang; Chen, Chih‐Hung; Teng, Michael Mu Huo; Peng, Giia‐Sheun; Sheng, Wen‐Yung; Hu, Han Hwa

doi:10.1161/strokeaha.109.575605

Cited by 112 publications

(76 citation statements)

References 29 publications

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“…23 Nevertheless, the rates of SICH according to various definitions in our cohort were comparable to those of an earlier multicenter study in Taiwan (Table 2). 21 The distinct discrepancy between the observed and predicted incidence of SICH per SITS-MOST in our population might be attributed to patient characteristics (SICH after tPA tended to happen earlier or caused more marked worsening of neurological symptoms), apart from inter-rater variability in assessment.…”

Section: Discussioncontrasting

confidence: 57%

Comparison of Risk-scoring Systems in Predicting Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis

Sung

Chen

Lin

et al. 2013

Stroke

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Background and Purpose— Various risk score models have been developed to predict symptomatic intracerebral hemorrhage (SICH) after intravenous thrombolysis for acute ischemic stroke. In this study, we aimed to determine the prediction performance of these risk scores in a Taiwanese population Methods— Prospectively collected data from 4 hospitals were used to calculate probability of SICH with the scores developed by Cucchiara et al, the Hemorrhage After Thrombolysis (HAT) score, the Safe Implementation of Thrombolysis in Stroke-SICH risk score, the Glucose Race Age Sex Pressure Stroke Severity score, and the Stroke Prognostication using Age and National Institutes of Health Stroke Scale-100 index. We used logistic regression to evaluate the effectiveness of each risk model in predicting SICH and the c statistic to assess performance. Results— A total of 548 patients were included. The rates of SICH were 7.3% by the National Institute of Neurological Diseases and Stroke definition, 5.3% by the European-Australasian Cooperative Acute Stroke Study II definition, and 3.5% by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study definition. The Cucchiara score, the HAT score, and the Safe Implementation of Thrombolysis in Stroke-SICH risk score were significant predictors of SICH for all 3 definitions, whereas the Glucose Race Age Sex Pressure Stroke Severity score and the Stroke Prognostication using Age and National Institutes of Health Stroke Scale-100 index predicted well only for 1 or 2 definitions of SICH. The c statistic was highest for the HAT score (range, 0.69–0.73) across the definitions of SICH. Conclusions— The Cucchiara score, the HAT score, and the Safe Implementation of Thrombolysis in Stroke-SICH risk score predicted SICH reasonably well regardless of which SICH definition was used. However, only the HAT score had an acceptable discriminatory ability.

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Section: Discussioncontrasting

confidence: 57%

Comparison of Risk-scoring Systems in Predicting Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis

Sung

Chen

Lin

et al. 2013

Stroke

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“…34,35 Although the sHT rate in the elderly who were given thrombolysis was higher than in the younger in our study, as previously reported, 11,12,17,19 neither the adjusted ORs were apparently different (5.27 in the aged ≥80 and 4.52 in the aged <80), nor there was signifi cant interaction between age group and thrombolysis (P=0.86). The VISTA group did not report the analysis results about sHT.…”

Section: Discussionsupporting

confidence: 53%

Effectiveness and Safety of Thrombolysis in Ischemic Stroke Patients Aged 80 Years or Older

Kim

Kwon

et al. 2012

Korean J Stroke

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“…[1][2][3] However, the Japanese drug safety authority has approved the use of alteplase at a dose of 0.6 mg per kilogram after an uncontrolled, open-label study showed that this dose resulted in equivalent clinical outcomes and a lower risk of intracerebral hemorrhage than that reported in published studies in which the 0.9-mg-per-kilogram dose was used. 4 Other registry studies in Asia [5][6][7][8][9][10][11] have shown inconsistent results, but a high risk of symptomatic intracerebral hemorrhage was observed among Asian patients treated with 0.9 mg of alteplase per kilogram in the United States. 12 Differing perceived risks of intracerebral hemorrhage and treatment affordability have led to variations in the doses of intravenous alteplase used to treat patients with acute ischemic stroke in Asia.…”

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Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke

et al. 2016

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BACKGROUNDThrombolytic therapy for acute ischemic stroke with a lower-than-standard dose of intravenous alteplase may improve recovery along with a reduced risk of intracerebral hemorrhage. METHODSUsing a 2-by-2 quasi-factorial open-label design, we randomly assigned 3310 patients who were eligible for thrombolytic therapy (median age, 67 years; 63% Asian) to lowdose intravenous alteplase (0.6 mg per kilogram of body weight) or the standard dose (0.9 mg per kilogram); patients underwent randomization within 4.5 hours after the onset of stroke. The primary objective was to determine whether the low dose would be noninferior to the standard dose with respect to the primary outcome of death or disability at 90 days, which was defined by scores of 2 to 6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]). Secondary objectives were to determine whether the low dose would be superior to the standard dose with respect to centrally adjudicated symptomatic intracerebral hemorrhage and whether the low dose would be noninferior in an ordinal analysis of modified Rankin scale scores (testing for an improvement in the distribution of scores). The trial included 935 patients who were also randomly assigned to intensive or guideline-recommended blood-pressure control. RESULTSThe primary outcome occurred in 855 of 1607 participants (53.2%) in the low-dose group and in 817 of 1599 participants (51.1%) in the standard-dose group (odds ratio, 1.09; 95% confidence interval [CI], 0.95 to 1.25; the upper boundary exceeded the noninferiority margin of 1.14; P = 0.51 for noninferiority). Low-dose alteplase was noninferior in the ordinal analysis of modified Rankin scale scores (unadjusted common odds ratio, 1.00; 95% CI, 0.89 to 1.13; P = 0.04 for noninferiority). Major symptomatic intracerebral hemorrhage occurred in 1.0% of the participants in the low-dose group and in 2.1% of the participants in the standard-dose group (P = 0.01); fatal events occurred within 7 days in 0.5% and 1.5%, respectively (P = 0.01). Mortality at 90 days did not differ significantly between the two groups (8.5% and 10.3%, respectively; P = 0.07). CONCLUSIONSThis trial involving predominantly Asian patients with acute ischemic stroke did not show the noninferiority of low-dose alteplase to standard-dose alteplase with respect to death and disability at 90 days. There were significantly fewer symptomatic intracerebral hemorrhages with low-dose alteplase.

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Outcomes of Thrombolytic Therapy for Acute Ischemic Stroke in Chinese Patients

Cited by 112 publications

References 29 publications

Comparison of Risk-scoring Systems in Predicting Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis

Comparison of Risk-scoring Systems in Predicting Symptomatic Intracerebral Hemorrhage After Intravenous Thrombolysis

Effectiveness and Safety of Thrombolysis in Ischemic Stroke Patients Aged 80 Years or Older

Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke

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