Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam
Background: To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (L...
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Frontiers Media S.A.
2021-04-01
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Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.653820/full |
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language |
English |
format |
Article |
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DOAJ |
author |
Duy Ton Mai Duy Ton Mai Viet Phuong Dao Van Chi Nguyen Van Chi Nguyen Dang Luu Vu Dang Luu Vu Tien Dung Nguyen Xuan Trung Vuong Quoc Viet Bui Ha Quan Phan Quang Tho Pham Hoang Kien Le Anh Tuan Tran Quang Anh Nguyen Phuc Duc Dang Hoang Nguyen Hoang Thi Phan Hoang Thi Phan |
spellingShingle |
Duy Ton Mai Duy Ton Mai Viet Phuong Dao Van Chi Nguyen Van Chi Nguyen Dang Luu Vu Dang Luu Vu Tien Dung Nguyen Xuan Trung Vuong Quoc Viet Bui Ha Quan Phan Quang Tho Pham Hoang Kien Le Anh Tuan Tran Quang Anh Nguyen Phuc Duc Dang Hoang Nguyen Hoang Thi Phan Hoang Thi Phan 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 acute ischemic stroke mechanical thrombectomy dose bridging therapy anterior large artery occlusion alteplase |
author_facet |
Duy Ton Mai Duy Ton Mai Viet Phuong Dao Van Chi Nguyen Van Chi Nguyen Dang Luu Vu Dang Luu Vu Tien Dung Nguyen Xuan Trung Vuong Quoc Viet Bui Ha Quan Phan Quang Tho Pham Hoang Kien Le Anh Tuan Tran Quang Anh Nguyen Phuc Duc Dang Hoang Nguyen Hoang Thi Phan Hoang Thi Phan |
author_sort |
Duy Ton Mai |
title |
Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam |
title_short |
Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam |
title_full |
Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam |
title_fullStr |
Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam |
title_full_unstemmed |
Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam |
title_sort |
low-dose vs. standard-dose intravenous alteplase in bridging therapy among patients with acute ischemic stroke: experience from a stroke center in vietnam |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2021-04-01 |
description |
Background: To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risks for intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over the potential 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 of bridging intravenous alteplase before MTE among LVO-AIS patients.Methods: We performed a retrospective analysis of LVO-AIS patients who were treated with either 0.6 mg/kg or 0.9 mg/kg alteplase prior to MTE at a stroke center in Northern Vietnam. Multivariable logistic regression models, accounting for potential confounding factors including comorbidities and clinical factors (e.g., stroke severity), were used to compare the outcomes between the two groups. Our primary outcome was functional independence at 90 days following stroke (modified Rankin score; mRS ≤ 2). Secondary outcomes included any ICH incidence, early neurological improvement, recanalization rate, and 90-day mortality.Results: We analyzed data of 107 patients receiving bridging therapy, including 73 with low-dose and 34 with standard-dose alteplase before MTE. There were no statistically significant 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 MTE had similar rates of successful recanalization, early neurological improvement, 90-day mortality, and ICH complications.Conclusion: In the present study, patients with low-dose alteplase before MTE were found to achieve comparable clinical outcomes compared to those receiving standard-dose alteplase bridging with MTE. The findings suggest potential benefits of low-dose alteplase in bridging therapy for Asian populations, but this needs to be confirmed by further clinical trials. |
topic |
acute ischemic stroke mechanical thrombectomy dose bridging therapy anterior large artery occlusion alteplase |
url |
https://www.frontiersin.org/articles/10.3389/fneur.2021.653820/full |
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doaj-508dc20c4cf34c0da13c98bc44ecce1e2021-04-09T06:40:14ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-04-011210.3389/fneur.2021.653820653820Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in VietnamDuy Ton Mai0Duy Ton Mai1Viet Phuong Dao2Van Chi Nguyen3Van Chi Nguyen4Dang Luu Vu5Dang Luu Vu6Tien Dung Nguyen7Xuan Trung Vuong8Quoc Viet Bui9Ha Quan Phan10Quang Tho Pham11Hoang Kien Le12Anh Tuan Tran13Quang Anh Nguyen14Phuc Duc Dang15Hoang Nguyen16Hoang Thi Phan17Hoang Thi Phan18Stroke Center, Bach Mai Hospital, Ha Noi, VietnamDepartment of Emergency and Intensive Care, Ha Noi Medical University, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamDepartment of Emergency and Intensive Care, Ha Noi Medical University, Ha Noi, VietnamDepartment of Emergency and Intensive Care, Ha Noi Medical University, Ha Noi, VietnamRadiology Center, Bach Mai Hospital, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamStroke Center, Bach Mai Hospital, Ha Noi, VietnamRadiology Center, Bach Mai Hospital, Ha Noi, VietnamRadiology Center, Bach Mai Hospital, Ha Noi, VietnamRadiology Center, Bach Mai Hospital, Ha Noi, VietnamStroke Department, The 103 Hospital, Ha Noi, VietnamWicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, AustraliaStroke Center, Bach Mai Hospital, Ha Noi, VietnamCollege of Health and Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, AustraliaBackground: To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risks for intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over the potential 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 of bridging intravenous alteplase before MTE among LVO-AIS patients.Methods: We performed a retrospective analysis of LVO-AIS patients who were treated with either 0.6 mg/kg or 0.9 mg/kg alteplase prior to MTE at a stroke center in Northern Vietnam. Multivariable logistic regression models, accounting for potential confounding factors including comorbidities and clinical factors (e.g., stroke severity), were used to compare the outcomes between the two groups. Our primary outcome was functional independence at 90 days following stroke (modified Rankin score; mRS ≤ 2). Secondary outcomes included any ICH incidence, early neurological improvement, recanalization rate, and 90-day mortality.Results: We analyzed data of 107 patients receiving bridging therapy, including 73 with low-dose and 34 with standard-dose alteplase before MTE. There were no statistically significant 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 MTE had similar rates of successful recanalization, early neurological improvement, 90-day mortality, and ICH complications.Conclusion: In the present study, patients with low-dose alteplase before MTE were found to achieve comparable clinical outcomes compared to those receiving standard-dose alteplase bridging with MTE. The findings suggest potential benefits of low-dose alteplase in bridging therapy for Asian populations, but this needs to be confirmed by further clinical trials.https://www.frontiersin.org/articles/10.3389/fneur.2021.653820/fullacute ischemic strokemechanical thrombectomydosebridging therapyanterior large artery occlusionalteplase |