Brunser Alejandro Michel, Mazzon Enrico, Cavada Gabriel, Mansilla Eloy, Rojo Alexis, Almeida Juan, Olavarría Verónica Viviana, Muñoz-Venturelli Paula, Lavados Pablo Manuel
Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Departamento de Urgencia, Santiago, Chile.
Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Servicio de Neurología, Unidad de Neurología Vascular, Departamento de Neurología y Psiquiatría, Santiago, Chile.
Arq Neuropsiquiatr. 2020 Nov;78(11):681-686. doi: 10.1590/0004-282X20200048.
Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability.
We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage.
Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018.
160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient's age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37‒14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98‒32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81‒357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37‒14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10‒0.40) remained independently associated.
Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs.
低剂量阿替普酶（LrtPA）在死亡/残疾方面已被证明不劣于标准剂量（SrtPA）。
我们旨在评估在ENCHANTED试验后我们中心接受LrtPA治疗的患者百分比以及与使用该剂量相关的因素。
对2016年6月至2018年11月期间收治的连续性急性卒中患者进行前瞻性研究。
160例患者接受了静脉溶栓治疗，其中50%为女性；平均年龄65.4±18.5岁。其中，48例患者（30%）接受了LrtPA。单因素分析中，LrtPA与患者年龄（p = 0.000）、既往改良Rankin量表评分（mRS）（p < 0.000）、高血压（p = 0.076）、糖尿病（p = 0.021）、高胆固醇血症（p = 0.19）、吸烟（p = 0.06）、心房颤动（p = 0.10）、冠状动脉疾病史（p = 0.06）、既往抗血小板药物治疗（p < 0.000）、入院国际标准化比值-INR（p = 0.18）、血小板计数（p = 0.045）、神经影像学上的白质疏松（p < 0.003）、溶栓治疗的禁忌证（p = 0.000）和血管内治疗（p = 0.027）相关。既往相关出血是LrtPA治疗的决定因素。卒中模拟的出院最终诊断对SrtPA治疗有显著意义（p = 0.02）。多因素分析中，mRS（比值比：2.21；95%置信区间1.37‒14.19）、既往抗血小板治疗（比值比：11.41；95%置信区间3.98‒32.70）、溶栓禁忌证（比值比：56.10；95%置信区间8.81‒357.80）、白质疏松（比值比：4.41；95%置信区间1.37‒14.10）和卒中模拟诊断（比值比：[0.22；95%置信区间0.10‒0.40]）仍独立相关。
在ENCHANTED试验之后，LrtPA在我们的患者中仅占30%。临床医生应用的标准主要基于可能增加脑或全身出血风险或将患者排除在溶栓药物治疗之外的临床变量。
