Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.
Cerebrovasc Dis. 2011;32(3):201-6. doi: 10.1159/000328813. Epub 2011 Aug 4.
Intravenous thrombolysis with alteplase for ischemic stroke is fixed at a maximal dose of 90 mg for safety reasons. Little is known about the clinical outcomes of stroke patients weighing >100 kg, who may benefit less from thrombolysis due to this dose limitation.
Prospective data on 1,479 consecutive stroke patients treated with intravenous alteplase in six Swiss stroke units were analyzed. Presenting characteristics and the frequency of favorable outcomes, defined as a modified Rankin scale (mRS) score of 0 or 1, a good outcome (mRS score 0-2), mortality and symptomatic intracranial hemorrhage (SICH) were compared between patients weighing >100 kg and those weighing ≤100 kg.
Compared to their counterparts (n = 1,384, mean body weight 73 kg), patients weighing >100 kg (n = 95, mean body weight 108 kg) were younger (61 vs. 67 years, p < 0.001), were more frequently males (83 vs. 60%, p < 0.001) and more frequently suffered from diabetes mellitus (30 vs. 13%, p < 0.001). As compared with patients weighing ≤100 kg, patients weighing >100 kg had similar rates of favorable outcomes (45 vs. 48%, p = 0.656), good outcomes (58 vs. 64%, p = 0.270) and mortality (17 vs. 12%, p = 0.196), and SICH risk (1 vs. 5%, p = 0.182). After multivariable adjustment, body weight >100 kg was strongly associated with mortality (p = 0.007) and poor outcome (p = 0.007).
Our data do not suggest a reduced likehood of favorable outcomes in patients weighing >100 kg treated with the current dose regimen. The association of body weight >100 kg with mortality and poor outcome, however, demands further large-scale studies to replicate our findings and to explore the underlying mechanisms.
由于安全性原因，阿替普酶静脉溶栓治疗缺血性脑卒中的最大剂量固定为 90mg。对于体重超过 100kg 的脑卒中患者，由于剂量限制，他们可能从溶栓治疗中获益较少，但我们对这些患者的临床结局知之甚少。
对瑞士 6 个脑卒中单元的 1479 例连续接受阿替普酶静脉溶栓治疗的脑卒中患者的前瞻性数据进行了分析。比较了体重>100kg 和体重≤100kg 的患者的发病特征以及良好结局（改良 Rankin 量表[mRS]评分 0 或 1、良好结局[mRS 评分 0-2]、死亡率和症状性颅内出血[SICH]的发生率。
与对照组（n=1384，平均体重 73kg）相比，体重>100kg（n=95，平均体重 108kg）的患者年龄较小（61 岁 vs. 67 岁，p<0.001），男性比例更高（83% vs. 60%，p<0.001），糖尿病患病率更高（30% vs. 13%，p<0.001）。与体重≤100kg 的患者相比，体重>100kg 的患者良好结局的发生率相似（45% vs. 48%，p=0.656）、良好结局的发生率相似（58% vs. 64%，p=0.270）和死亡率（17% vs. 12%，p=0.196）以及 SICH 风险（1% vs. 5%，p=0.182）。多变量调整后，体重>100kg 与死亡率（p=0.007）和不良结局（p=0.007）显著相关。
我们的数据并未表明，目前剂量方案治疗的体重>100kg 的患者不太可能获得良好的结局。然而，体重>100kg 与死亡率和不良结局的关联需要进一步的大规模研究来复制我们的发现，并探讨潜在的机制。
