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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


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, 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 Article online ahead of print. ISSN 1664-2295 (2021) [Refereed Article]


Copyright Statement

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

DOI: doi:10.3389/fneur.2021.653820


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 0.293.52) 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 standarddose 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.

Item Details

Item Type:Refereed Article
Keywords:stroke, intravenous thrombolysis, bridging therapy, outcome, dose
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Provision of health and support services
Objective Field:Inpatient hospital care
UTAS Author:Nguyen, H (Dr Hoang Nguyen)
UTAS Author:Phan, HT (Dr Hoang Phan)
ID Code:143925
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2021-04-11
Last Modified:2021-06-22
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