Low-dose versus standard-dose alteplase for intravenous thrombolysis in patients with acute ischemic stroke in Iran: Results from the safe implementation of treatments in stroke registry

Elyar Sadeghi-Hokmabadi; Abdoreza Ghoreishi; Reza Rikhtegar; Payam Sariaslani; Shahram Rafie; Alireza Vakilian; Ehsan Sharifipour; Masoud Mehrpour; Mohammad Saadatnia; Mohammad  Mirza-Aghazadeh-Attari; Mehdi Farhoudi

doi:10.18502/cjn.v20i4.8346

Elyar Sadeghi-Hokmabadi Neurosciences Research Center AND Division of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Abdoreza Ghoreishi Stroke Research Group, Vali-e-Asr Hospital AND Department of Neurology and Stroke Unit, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Reza Rikhtegar Institute of Diagnostic and Interventional Radiology and Neuroradiology, School of Medicine, Essen University Hospital, Germany
Payam Sariaslani Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
Shahram Rafie Department of Neurology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Alireza Vakilian Department of Neurology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Ehsan Sharifipour Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
Masoud Mehrpour Iranian Stroke Association, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Mohammad Saadatnia Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Mohammad Mirza-Aghazadeh-Attari Medical Imaging Research Group, Tabriz University of Medical Sciences, Tabriz, Iran
Mehdi Farhoudi Neurosciences Research Center AND Division of Neurology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

DOI: https://doi.org/10.18502/cjn.v20i4.8346

Keywords: Stroke; Tissue Plasminogen Activator; Cerebral Hemorrhage; Ethnicity

Abstract

Background: Rates of intracranial hemorrhage (ICH) after intravenous thrombolysis (IVT) differ depending regard are scarce in the Middle Eastern region.

Methods: The present retrospective study was performed on data extracted from the Safe Implementation of Treatments in Stroke (SITS) registry. Computed tomography (CT) image analysis was based on the SITS-Monitoring Study (SITS-MOST) definition for symptomatic ICH (SICH). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Multivariate logistic regression including adjusted analysis was used for comparison between groups.

Results: Of 6615 patients, 1055 were enrolled. A total of 86% (n = 906) received a standard dose and 14% (n = 149) received a low dose of alteplase. Favorable 3-month outcome was achieved in 481 (53%) patients in the standard group and 71 (48%) patients in the low-dose group [adjusted odds ratio (AOR) = 1.24, 95% confidence interval (CI): 0.87-1.75, P = 0.218]. SICH occurred in 14 (1.5%) patients in the standard group and 3 (2%) patients in the low-dose group [odds ratio (OR) = 2.77, 95% CI: 0.36-21.04, P = 0.120]. At 3 months, mortality occurred in 145 (16.0%) patients in the standard group and 29 (19.4%) patients in the low-dose group (OR = 1.22, 95% CI: 0.78-1.91, P = 0.346).

Conclusion: Low-dose compared to standard-dose alteplase for patients with acute ischemic stroke (AIS) was not associated with fewer hemorrhagic events and there was no significant difference in the favorable 3-month outcome (mRS: 0-2) or mortality rate.