Division of Neurology, National University Health System, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
J Thromb Thrombolysis. 2020 Nov;50(4):921-928. doi: 10.1007/s11239-020-02118-3.
Intravenously administered tissue plasminogen activator (IV-tPA), dose determined by patients' body-weight, remains the only approved drug treatment for acute ischemic stroke (AIS). Since a shorter onset-to-treatment time results in better functional outcome, treatment is often initiated according to the estimated or last-known body-weight of the patient. This approach may result in underdosing or overdosing of tPA. In this multicenter retrospective study, we evaluated the extent of error in tPA dosing in our AIS cohort and its impact on functional outcome and symptomatic intracranial hemorrhage (SICH). Consecutive AIS patients, receiving IV-tPA, dose determined by the estimated body-weight, at three tertiary centers between January and December 2017 were included. Collected data included information about demographics, cardiovascular risk factors, stroke subtype and National Institute of Health Stroke Scale (NIHSS) score. Estimated and measured body-weights were recorded. Modified Rankin scale (mRS) of 2 or more defined unfavorable outcome. The study included 150 patients. Median age was 64 -years (IQR 55-75) with male preponderance (67%) and median NIHSS score of 9 points (IQR 6-17). Mean measured weight of our study population was 58 (SD 13) kg. Median difference between actual and estimated body-weight was 3 kg (IQR 1.5-6). Difference was more than 10% in 35 (23.3%) patients. Good functional outcome (mRS 0-1) was achieved by 74 (49.3%) patients and 10 (6.8%) developed SICH. NIHSS (OR 1.288; 95% CI 1.157-1.435, p < 0.001) and large artery atherosclerosis (OR 5.878; 95% CI 1.929-17.910, p = 0.002) were independent predictors of unfavorable functional outcome. Our finding of the statistically insignificant 2.5-fold increase in poor outcomes among patients where the estimated and actual weight differed by more than 10% should be interpreted with caution due to the limited sample size. Significant difference occurs between estimated and actual body-weight in a considerable proportion of thrombolysed AIS patients. However, this discrepancy does not affect functional outcome or the risk of SICH.
静脉注射组织型纤溶酶原激活剂（IV-tPA），根据患者体重确定剂量，仍然是急性缺血性脑卒中（AIS）唯一批准的药物治疗方法。由于发病到治疗的时间越短，功能预后越好，因此通常根据患者的估计或最后一次已知体重来启动治疗。这种方法可能导致 tPA 的剂量不足或过量。在这项多中心回顾性研究中，我们评估了我们的 AIS 患者群体中 tPA 给药剂量的误差程度及其对功能预后和症状性颅内出血（SICH）的影响。2017 年 1 月至 12 月，在三个三级中心接受 IV-tPA 治疗，根据估计体重确定剂量的连续 AIS 患者被纳入研究。收集的数据包括人口统计学、心血管危险因素、卒中亚型和美国国立卫生研究院卒中量表（NIHSS）评分的信息。记录了估计体重和实测体重。改良 Rankin 量表（mRS）评分 2 或更高定义为不良预后。该研究纳入了 150 名患者。中位年龄为 64 岁（IQR 55-75），男性居多（67%），NIHSS 评分中位数为 9 分（IQR 6-17）。我们研究人群的平均实测体重为 58（SD 13）kg。实际体重与估计体重的中位数差异为 3kg（IQR 1.5-6）。在 35 名患者（23.3%）中差异超过 10%。74 名患者（49.3%）获得了良好的功能预后（mRS 0-1），10 名患者（6.8%）发生了 SICH。NIHSS（OR 1.288；95%CI 1.157-1.435，p<0.001）和大动脉粥样硬化（OR 5.878；95%CI 1.929-17.910，p=0.002）是不良功能预后的独立预测因素。我们发现，在估计体重和实际体重相差超过 10%的患者中，不良预后的风险增加了 2.5 倍，但由于样本量有限，这一结果应谨慎解释。在相当一部分接受溶栓治疗的 AIS 患者中，估计体重和实际体重之间存在显著差异。然而，这种差异并不影响功能预后或 SICH 的风险。
