Thrombolysis With 0.6 Mg/kg Intravenous Alteplase For Acute Ischemic Stroke: A Single-centre Study

Objective:Contrast the effectiveness and safety of the low-dose versus standard-dose intravenous alteplase for acute ischemic stroke,to provide single-center clinical evidence on alteplase.Methods:A retrospective study of 132 cases of patients with acute ischemic stroke in the department of neurology of China-Japan union hospital of jilin university from August 2016 to February 2018.According to the dosage of rt-PA of patients with acute ischemic stroke,these patients were divided into the low dosage group(0.6mg/kg)and standard dosage group(0.9 mg/kg),the low dosage group included 43 patients,standard dosage group included 90 patients.Collecting all patients’ clinical data,Contrast the NIHSS score in 24 hours,in 7 days,effective rate of treatmeat in 7days and the mRS score,the rate of favorable prognosis(mRS<2)at 90 days et al.Contrast the safety index of intracranial hemorrhage(ICH)in 36 hours after the intrvenous thrombolysis and the mortality at 90 days follow-up period.Results:1.NIHSS scores after treatment in 24 hours,in 7day were significantly decreased as compared with that before treatment in both groups(p < 0.05),NIHSS scores after treatment in 24 hours,in 7days had no significant difference in 2 groups(p > 0.05).2.The effective rate of treatmeat in 7 days between the low dosage group and the standard dosage group had no significant difference(71.4% vs 76.6%,p>0.05).3.The m RS score after intravenous thrombolysis at 90 days were significantly decreased as compared with that before treatment in both groups(p < 0.05),mRS aftertreatment at 90 days had no significant difference in 2 groups(p > 0.05).4.There was no significant difference in the rate of favorable prognosis(mRS<2)at 90 days in 2 groups(60.5% vs 63.1%,p>0.05).5.There was no significant difference in the total mortality at 90 days follow-up period between the low-dose group and the standard dose group(p > 0.05).6.There was no significant difference in the total incidence of intracranial hemorrage(ICH)(4.7% vs 12.2%,p <0.05),but low-dose group was lower than the standard dose group in incidence of symptomatic intracranial hemorrage(sICH)(0 vs10%,p < 0.05).Conclusion:This study suggests that there is similar clinical efficacy between the low-dosage alteplase(0.6 mg/kg)and the standard-dosage alteplase(0.9 mg/kg)for acute ischemic stroke.Although the incidence of symptomatic intracranial hemorrage of the standard-dose group is higher,but there is no significant increase in the 90 d mortality rate.Based on the considerations of economic and security,the low alteplase(0.6mg/kg)can be used in early intravenous thrombolytic therapy for acute ischemic stroke.But a larger sample subgroup comparative analysis is needed.